Abstract 15414: Driving Distances and Durations to Nearest Transcatheter Aortic Valve Replacement Center for Medicare Beneficiaries Across Continental United States

Abstract

Background: Transcatheter aortic valve replacement (TAVR) is a rapidly expanding minimally invasive procedure. Although many centers across the continental US offer TAVR, accessibility is a consideration given extensive pre- and post-procedural care. We examined access to TAVR amongst Medicare beneficiaries across the US. Methods: We identified TAVR providers based on clinician billing records for CPT codes 33361-33369 in the 2020 Medicare provider dataset, available from Centers for Medicare and Medicaid Services. Residential and practice zip codes were identified from national geopolitical data. Across the US, haversine spherical pairwise straight-line distances were computed between all residential and provider zip codes. Based on proximate residential and provider zip code pairs, we used the Google Distance Matrix API to calculate average driving distance and travel time to providers for all residential zip codes. Results: There were 936 TAVR providers across 409 US zip codes, against a total of 29,089 residential US zip codes. Wyoming had no TAVR providers, while Florida had the most (n=69). Median travel duration (minutes) was lowest in the District of Columbia (20 min) and greatest in Montana (282 min). The median [IQR] traveling distance (miles) to the closest TAVR site was lowest in the Northeast (30 [13-55]) and greatest for the West (84 [29-151]), with the Midwest (46 [24-74]) and South (57 [26-90] in between (p < 0.001). The median [IQR] traveling duration (minutes) showed similar trends to distance (Northeast: (38 [22-66]); Midwest: (52 [30-80]); South: (64 [34-97]); West: 91 [40-158]); p < 0.001); Figure 1 ). 75% of zip codes travel a minimum of 30 minutes to the nearest TAVR provider. Conclusions: There are significant regional differences for TAVR accessibility in the US, with extended travel times of over 1 hour for 1 in 2 US zip codes and over 2 hours for 1 in 7 US zip codes to receive standard care.