Abstract No. 220 Percutaneous and surgical ablation versus partial nephrectomy for renal cell carcinoma: Medicare volume and physician payment trends from 2010 to 2018

Abstract

A growing body of evidence demonstrates comparable outcomes for percutaneous ablation and partial nephrectomy for the treatment of renal tumors, along with lower morbidity and decreased cost for the former. The purpose of this study is to analyze trends in Medicare volume and physician reimbursement for these procedures from 2010 to 2018 and compare physician payments. Claims from the Medicare Part B Physician/Supplier Procedure Summary for the years 2010 to 2018 were extracted using the CPT codes for percutaneous and laparoscopic ablations and surgical and laparoscopic partial nephrectomy of renal tumors. Total volumes, physician payment, and trends were analyzed by procedure. From 2010 to 2018, overall volume of percutaneous ablation increased from 2539 to 4571 procedures (80.0%). Specifically, percutaneous cryoablation became the dominant technique, increasing from 1434 to 2981 procedures (107.9%). Overall, volume of partial nephrectomy also increased by 40.4%, driven by an increase in laparoscopic partial nephrectomy from 3227 to 7770 procedures (140.8%) with a decrease in open partial nephrectomy from 3489 to 1661 (-52.4%). There was also a 72.7% decrease in surgical ablations from 1260 to 344 procedures over this time period. In 2018, average physician payment for percutaneous ablation was $351.28, compared to $687.80 for surgical ablation, $802.67 for open partial nephrectomy, and $925.21 for laparoscopic partial nephrectomy. There has been a trend toward more minimally invasive techniques for treatment of renal cell carcinoma among Medicare patients. In the setting of a growing body of evidence showing comparable outcomes with surgery for smaller tumors, the volume of percutaneous ablation (particularly cryoablation) has increased by 80% from 2010 to 2018. There is also a strong physician payment cost advantage for this treatment over all surgical techniques.