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Socioeconomics
Original research
Recent trends in high-volume Medicare stroke thrombectomy provider characteristics
  1. Keshav Jayaraman1,
  2. Stefan Santavicca2,
  3. Danny R Hughes2,3,
  4. Joshua A Hirsch4,
  5. Richard Duszak, Jr.2,
  6. Arindam R Chatterjee1
  1. 1 Mallinckrodt Institute of Radiology, Department of Neurosurgery and Department of Neurology, Washington University in St Louis School of Medicine, St Louis, Missouri, USA
  2. 2 Radiology and Imaging Sciences, Emory University, Atlanta, Georgia, USA
  3. 3 School of Economics, Georgia Institute of Technology, Atlanta, Georgia, USA
  4. 4 Massachusetts General Hospital, Boston, Massachusetts, USA
  1. Correspondence to Dr Arindam R Chatterjee, Mallinckrodt Institute of Radiology, Department of Neurosurgery and Department of Neurology, Washington University in St Louis School of Medicine, St Louis, Missouri, USA; chatterjee{at}wustl.edu

Abstract

Background Intracranial mechanical thrombectomy (MT) is increasingly indicated for use in acute ischemic stroke patients. We analyzed recent trends in the characteristics and geographic distributions of physicians providing this service with frequency to Medicare beneficiaries.

Methods We linked public data sources to elucidate and visualize trends in high-volume MT providers between 2016 and 2019.

Results High-volume MT providers increased by 184% between 2016 and 2019. The number of neurosurgeons, neurologists, and radiologists in this physician population increased by 251%, 205%, and 139%, respectively. Male practitioners accounted for 96% of providers in the most recent year of analysis. International medical graduates accounted for roughly one-third of these physicians across all 4 years of analysis. As of 2019, the three states with the most high-volume MT providers were Florida, California, and Texas, accounting for 7%, 7%, and 6% of providers, respectively.

Conclusions High-volume providers of MT services for Medicare beneficiaries represent a dynamic and rapidly expanding subset of physicians with diverse specialty backgrounds.

  • thrombectomy
  • stroke
  • economics

Data availability statement

Data are available in a public, open access repository. Requests for Medicare data should be directed to the Center for Medicare and Medicaid Services (CMS). The data used to create our manually curated database are available publicly on the internet.

https://doi.org/10.1136/neurintsurg-2021-018611

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    Data availability statement

    Data are available in a public, open access repository. Requests for Medicare data should be directed to the Center for Medicare and Medicaid Services (CMS). The data used to create our manually curated database are available publicly on the internet.

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    Footnotes

    • Presented at Previous presentations: portions of this work have been previously presented at the American College of Radiology 2021 Annual Meeting.

    • Contributors All authors (KJ, SS, DRH, JAH, RD and ARC) contributed significantly to this project and were involved with all critical stages including but not limited to project planning, data analysis and/or interpretation, and final manuscript preparation. ARC acts as the guarantor accepting full responsibility for the work and conduct of the study, has access to the data, and controlled the decision to publish.

    • Funding Dr Duszak’s, Dr Hirsch’s, Dr Hughes’ and Mr Santavicca’s efforts were supported in part by the Harvey L. Neiman Health Policy Institute.

    • Map disclaimer The inclusion of any map (including the depiction of any boundaries therein), or of any geographic or locational reference, does not imply the expression of any opinion whatsoever on the part of BMJ concerning the legal status of any country, territory, jurisdiction or area or of its authorities. Any such expression remains solely that of the relevant source and is not endorsed by BMJ. Maps are provided without any warranty of any kind, either express or implied.

    • Competing interests JAH is a member of the JNIS editorial board and serves as a Deputy Editor of the JNIS. JAH additionally holds or held the following leadership positions: Chair of the SNIS’ Health Policy Committee, Past President of the ASNR and Board Member of ASIPP. RD is a member of the Board of Chancellors of the American College of Radiology. JAH – consulting fees from Medtronic, Persica and Spine Biopharma.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.