News: Increase in outpatient vascular procedures correlates with high reimbursement rates, analysis finds

CDI Strategies - Volume 17, Issue 22

From 2017 to 2021, the top 5% of doctors who conducted atherectomies (about 90 physicians) accounted for more than a third of all procedures and government payments, according to a ProPublica analysis. Using CMS and Medicare data, researchers found that from 2013 to 2021 the number of atherectomies has doubled and payments to doctors have nearly tripled, totaling about $503 million in 2021. CMS paid one doctor more than $30 million in the past decade for vascular procedures performed on hundreds of patients.

The increase in the number of atherectomies correlates with the increase in pay CMS officials put into place for doctors’ offices that deployed balloons and stents to widen arteries, starting in 2008. In 2011, they also started reimbursing those offices for atherectomies. An office provider would make about $1,700 from Medicare for inserting a stent and about $3,800 for deploying a balloon before the change; after the increase, those rose to $6,400 and $4,800 respectively. Atherectomies conducted in offices were reimbursed at a rate of about $13,500 per procedure, in comparison to about $11,450 in a hospital.

While the intent was to reduce the growing hospital costs for vascular care, in actuality they ended up paying more. Atherectomies increased by 60% from 2011 to 2014, and Medicare’s overall costs for peripheral vascular treatments climbed by nearly half a billion dollars (18%).

Research in 2014 indicated atherectomies may not be more effective than cheaper alternatives, and experts cautioned the procedure could be associated with a higher risk of complications in 2019. Around the same time, researchers warned CMS that some doctors could potentially be abusing interventions and suggested the agency scrutinize its data to identify overuse as some doctors could pose an “immediate threat to public safety.” The ProPublica analysis suggests that, if the agency had taken such advice, it would have discovered that a small pool of physicians have been performing a disproportionate number of treatments.

Unconditional payments for vascular procedures with no monitoring in place exhibits a large issue with the American healthcare system, experts told ProPublica. “The government is really to blame for setting these tremendously high reimbursement values without looking into whether these procedures are helping people or are just worthless procedures or, in fact, are hurting people,” said Dr. Dipankar Mukherjee, a vascular surgeon and chief of vascular surgery at Inova Fairfax Hospital in Virginia, one such expert. While hospitals have panels and administrators to spot adverse events and questionable billing, these outpatient locations often do not face such scrutiny.

Other experts the publication reached out to recommended that CMS reduce its outpatient reimbursements and investigate doctors with outsized procedure patterns. Many physicians also support better data collection, particularly for newer technologies like atherectomy, to ensure safety and improved outcomes.

Editor’s note: To read the full story released by ProPublica, click here.

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