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Vascular neurology
Procedural, workforce, and reimbursement trends in neuroendovascular procedures
  1. Kyle Steiger1,
  2. Rohin Singh2,
  3. W Christopher Fox3,
  4. Stefan Koester4,
  5. Nolan Brown2,
  6. Shane Shahrestani2,
  7. David A Miller5,
  8. Naresh P Patel2,
  9. Joshua S Catapano6,
  10. Visish M Srinivasan6,
  11. James F Meschia7,
  12. Young Erben1
  1. 1 Division of Vascular and Endovascular Surgery, Mayo Clinic in Florida, Jacksonville, Florida, USA
  2. 2 Neurosurgery, Mayo Clinic Arizona, Scottsdale, Arizona, USA
  3. 3 Neurosurgery, Mayo Clinic in Florida, Jacksonville, Florida, USA
  4. 4 Vanderbilt University School of Medicine, Nashville, Tennessee, USA
  5. 5 Radiology, Mayo Clinic in Florida, Jacksonville, Florida, USA
  6. 6 Neurosurgery, Barrow Neurological Institute, Phoenix, Arizona, USA
  7. 7 Neurology, Mayo Clinic in Florida, Jacksonville, Florida, USA
  1. Correspondence to Dr Young Erben, Division of Vascular and Endovascular Surgery, Mayo Clinic in Florida, Jacksonville, FL 32224, USA; Erben.Young{at}mayo.edu

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’ 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.

  • Stroke
  • Thrombectomy
  • Catheter
  • Economics
  • CT Angiography

Data availability statement

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.

https://doi.org/10.1136/jnis-2022-019297

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    Data availability statement

    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.

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    Footnotes

    • Twitter @wchrisfox

    • Contributors KS drafted the article. RS and KS were responsible for data collection, conception, and design. SK was responsible for data analysis and interpretation. WCF, NB, SS, DAM, NPP, JSC, VMS, JFM, and YE assisted in data interpretation. All authors participated in critical revision, approval of the final manuscript, and agree to be accountable for all aspects related to the integrity of this research.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • 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 YME receives a grant from the National Institutes of Health for a study in neurology: Expanding insights into FTD disease mechanisms (R35NS097273-01). JFM is chair of the NeuroNEXT Data Safety Monitoring Board and receives grants from the National Institutes of Health for several studies related to stroke: CREST-2 Clinical Coordinating Center (U01NS080168), CREST-2 Long-term Observational Extension (U01NS119169), and DISCOVERY Recruitment and Retention Core (U19NS115388). SS is a stockholder and board member of StrokeDx.

    • 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.