PO-02-048 U.S. TRENDS IN THE HIGH-VOLUME MEDICARE CARDIAC IMPLANTABLE ELECTRONIC DEVICE EXTRACTION WORKFORCE, 2013-2020

Abstract

Extraction of cardiac implantable electronic devices (CIEDs) is a complex potentially life-saving procedure performed by a subset of specially trained cardiac electrophysiologists and surgeons. Approximately 60% of US CIED extraction procedures occur in Medicare beneficiaries. High volume CIED extractors (HVE) have superior outcomes and the Heart Rhythm Society recommends a minimum of 15 CIED extractions/extractor/year to maintain competence. To examine nationwide trends in the Medicare CIED HVE workforce and CIED extraction volume in the US. Using data from the Medicare Provider Utilization and Payment Database (MPUPD) we identified all extractors who used an individual transvenous CIED extraction procedure code (CPT 33234, 33235, 33244) >10 times in any year from 2013-2020. The number, demographics, and location of these HVEs were trended over the study period. There were an average of 1621 CIED extractions performed annually by 74 HVEs over the study period. Only 5% (n=3) of HVEs were women (Figure Panel A). During the 8-year period, the number of HVEs in the MPUPD as well as the total number of CIED extraction procedures performed by HVEs decreased by 60% (Figure Panel A, C). The proportion of women HVEs remained unchanged (Figure Panel A). In 2020, fewer than 50% of states had a HVE and only 2 states had a woman HVE (Figure Panel B). The median procedural volume between represented men and women HVEs was similar. A minority of cardiac electrophysiologists and surgeons perform a high volume of CIED extractions and the number of HVEs is declining, leading to a growing disparity of geographic availability. Future study is needed to determine whether fewer CIED extractions are being performed or a greater proportion of CIED extractions are being performed by lower volume extractors.