Abstract 16487: Variation in Provider Practice Patterns Across Clinical Settings for Medicare Beneficiaries Undergoing Endovascular Femoropopliteal Artery Revascularization

Abstract

Introduction: After CMS established bundled payments for outpatient peripheral vascular intervention (PVI) in 2008, a large proportion of PVIs shifted to outpatient settings, including ambulatory surgery centers (ASCs) and office-based laboratories (OBLs). Little is known about these free-standing procedural centers, such as their proximity to tertiary care hospitals and the characteristics of patients being treated. Methods: Medicare fee-for-service beneficiaries ≥66 years undergoing femoropopliteal artery PVI from 4/1/15-12/31/17 in outpatient settings were identified in the CMS Carrier file linked to institutional outpatient files. The exposure was treatment at an ASC/OBL versus an outpatient hospital. An area deprivation index of ≤15th percentile identified those who reside in regions of lower socioeconomic status (SES). The primary business address of each ASC/OBL was identified using the National Provider Identifier. The address of the closest tertiary care hospital was identified in the Medicare Hospital database and distances were calculated using a Google Maps API platform. Results: Of 1,155 providers who performed ≥1 PVI in an ASC/OBL, the average distance to the nearest hospital was 1.5±2.2 miles. There was a weak correlation between the proportion of procedures performed at ASCs/OBLs and the distance to the nearest hospital (Figure). Among 686 providers who performed procedures in both ASCs/OBLs and outpatient hospitals, patients treated in ASCs/OBLs had a higher burden of comorbidities and were more often Black, dually-enrolled in Medicare/Medicaid, and residing in lower SES regions. Conclusions: ASCs/OBLs are geographically close to tertiary care centers, with little correlation between the proportion of procedures performed and the distance to the nearest hospital. The heterogeneity of patient characteristics across outpatient settings underscores the need for better measures of quality and appropriateness of PVI procedures.