Abstract No. 600 Lower extremity endovascular revascularization for Medicare beneficiaries

Abstract

This study evaluates the state-level practice of vascular surgery (VS), interventional cardiology (IC), and interventional radiology (IR) in lower extremity endovascular revascularization (LEER) for Medicare beneficiaries. We used the 2015 Centers for Medicare & Medicaid Services’ (CMS’s) “Provider Utilization and Payment Data Physician and Other Supplier Public Use File.” The database includes type of service, provider-specific inpatient and outpatient charges, and actual Medicare reimbursements for each CPT code. LEER-specific CPT codes were extracted from this database. 4,113 providers submitted claims for iliac (733), femoropopliteal (2184), and tibioperoneal (1196) endovascular revascularization. Nationwide, in the inpatient setting, VS performed approximately 52% of the procedures followed by IC (32%) and IR (8%). In the outpatient setting, the corresponding numbers were 46%, 36% and 13%, respectively. Florida (443), Texas (389) and California (341) had the highest number of providers. In these three states 53%, 40%, and 60% of LEERs were performed in an outpatient setting, respectively. VS, IC, and IR performed 58%, 27%, and 11% of inpatient LEERs in Florida. California followed a similar trend as Florida. However in Texas, VS, IC, and IR performed 42%, 40% and 7%, respectively. Nationwide, the average submitted physician fees by VS, IC, and IR were $4300, $3,500, $3,600 with actual reimbursements of $370, $406, and $390, respectively. The average submitted charges for outpatient LEER by VS, IC, and IR were $23,000, $23,000, and $22,000 with reimbursements of $6,700, $6,700, and $6,000, respectively. There was significant interstate variability in the submitted charge of care by the different specialties, but there was minimal variability in the actual Medicare reimbursements. This study demonstrates the current practice of VS, IC, and IR in LEER and summarizes the state-level variability in the submitted charge of care and actual Medicare reimbursements.