@article {Steigerjnis-2022-019297, author = {Kyle Steiger and Rohin Singh and W Christopher Fox and Stefan Koester and Nolan Brown and Shane Shahrestani and David A Miller and Naresh P Patel and Joshua S Catapano and Visish M Srinivasan and James F Meschia and Young Erben}, title = {Procedural, workforce, and reimbursement trends in neuroendovascular procedures}, elocation-id = {jnis-2022-019297}, year = {2022}, doi = {10.1136/jnis-2022-019297}, publisher = {British Medical Journal Publishing Group}, abstract = {Background This study aims to define the proportion of Medicare neuroendovascular procedures performed by different specialists from 2013 to 2019, map the geographic distribution of these specialists, and trend reimbursement for these procedures.Methods The Medicare Provider Utilization Database was queried for recognized neuroendovascular procedures. Data on specialists and their geographic distribution were tabulated. Reimbursement data were gathered using the Physician Fee Schedule Look-Up Tool and adjusted for inflation using the United States Bureau of Labor Statistics{\textquoteright} Consumer Price Index Inflation calculator.Results The neuroendovascular workforce in 2013 and 2019, respectively, was as follows: radiologists (46\% vs 44\%), neurosurgeons (45\% vs 35\%), and neurologists (9\% vs 21\%). Neurologists increased proportionally (p=0.03). Overall procedure numbers increased across each specialty: radiology (360\%; p=0.02), neurosurgery (270\%; p\<0.01), and neurology (1070\%; p=0.03). Neuroendovascular revascularization (CPT 61645) increased in all fields: radiology (170\%; p\<0.01), neurosurgery (280\%; p\<0.01), neurology (240\%; p\<0.01); central nervous system (CNS) permanent occlusion/embolization (CPT61624) in neurosurgery (67\%; p=0.03); endovascular temporary balloon artery occlusion (CPT61623) in neurology (29\%; p=0.04). In 2019, radiologists were the most common neuroendovascular specialists everywhere except in the Northeast where neurosurgeons predominated. Inflation adjusted reimbursement decreased for endovascular temporary balloon occlusion (CPT61623, -13\%; p=0.01), CNS transcatheter permanent occlusion or embolization (CPT61624, -13\%; p=0.02), non-CNS transcatheter permanent occlusion or embolization (CPT61626, -12\%; p\<0.01), and intracranial stent placement (CPT61635, -12\%; p=0.05).Conclusions The number of neuroendovascular procedures and specialists increased, with neurologists becoming more predominant. Reimbursement decreased. Coordination among neuroendovascular specialists in terms of training and practice location may maximize access to acute care.Data are available in a public, open access repository. All data for this study were obtained from free and publicly available datasets cited within the article. Additionally, we provide supplementary tables that should allow others to independently replicate and critique our statistical analysis.}, issn = {1759-8478}, URL = {https://jnis.bmj.com/content/early/2022/08/11/jnis-2022-019297}, eprint = {https://jnis.bmj.com/content/early/2022/08/11/jnis-2022-019297.full.pdf}, journal = {Journal of NeuroInterventional Surgery} }