Abstract No. 196 Percutaneous ablation of lung tumors has failed to gain traction: Medicare volume and physician reimbursement trends from 2012 to 2018

Abstract

To analyze trends in Medicare volume and physician reimbursement for percutaneous lung ablation versus resection from 2012 to 2018 Claims from the Medicare Part B PSPSMF for the years 2012 to 2018 were extracted using the CPT codes for percutaneous ablation of lung tumors as well as video-assisted thoracoscopic (VATS) and open wedge resection and segmentectomy. Total volumes and physician payments were analyzed. Unexpectedly, from 2012 to 2018, overall volume of percutaneous ablation decreased from 652 to 518 procedures (-20.6%). In 2018, 317 were coded as radiofrequency ablation (RFA) and 201 as cryoablation. A large majority were performed by radiology (92.2% in 2012 and 96.3% in 2018) with only a small minority performed by thoracic surgery. Volume of wedge resection and segmentectomy also decreased from 16,488 to 14,619 procedures (-11.3%). Specifically, the volume of open resection decreased from 6,249 to 3,183 (-49.1%), while the volume of VATS resection increased from 10,239 to 11,436 (11.7%). In 2018, average physician reimbursement was $372.28 and $417.38 for percutaneous RFA and cryoablation, respectively. Reimbursement was $573.14 for open resection and $626.75 for VATS. Despite a growing body of evidence in favor of percutaneous ablation of lower stage lung tumors, its use in Medicare patients has declined from 2012 to 2018. This minimally invasive procedure is particularly important in this population that includes older patients with more comorbidities. The findings of this study suggest that evidence-based medicine has not impacted entrenched practice patterns in treatment of lower stage lung tumors.