Increase in utilization of percutaneous renal artery interventions by medicare beneficiaries, 1996-2000

Our purpose was to review data from Medicare physician claims to ascertain differences in annual volumes of renal artery interventions versus surgery and differences in utilization of renal artery interventions among geographic regions according to physician provider type between 1996 and 2000.

We analyzed claims submitted to Medicare in 1996, 1998, and 2000 and extracted claims for renal artery angioplasty, stent placement, or bypass surgery. Analyses were performed for percutaneous renal artery interventions categorized by Centers for Medicare & Medicaid Services (CMS) geographic region and physician provider type.

Between 1996 and 2000, the total volume of renal revascularization (surgical and percutaneous) increased 62%, from 13,380 to 21,660 procedures. The annual volume of renal artery surgery decreased 45% in 2000, compared with the volume in 1996. Annual volumes of renal artery angioplasty and stent placement increased 2.4-fold in 2000 compared with those in 1996. Most growth in percutaneous renal artery interventions is attributed to added provision by cardiologists, who increased their annual volume 3.9-fold. More than a threefold difference in rates of use of renal artery interventional procedures across CMS regions was found. In the Southeast region, the volume of renal artery interventions by cardiologists increased more than 15-fold.

Among Medicare beneficiaries, the volume of percutaneous renal artery interventions is increasing rapidly, whereas the volume of renal artery surgery is declining. Most growth in percutaneous renal artery revascularization is attributed to increased performance by cardiologists; explosive growth in annual procedure volume by cardiologists occurred in some regions. Marked disparity in use among CMS regions was found.