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Bundling of Reimbursement for Inferior Vena Cava Filter Placement Resulted in Significantly Decreased Utilization
Roan J Glocker1, Matthew J TerBush1, Elaine L Hill1
1Department of Surgery, University of Rochester, Rochester, NY.
Insights
Reimbursement changes significantly reduced inferior vena cava filter (IVCF) utilization. This study found a notable decrease in IVCF procedures following Medicare bundling, indicating a potential shift in clinical practice.
Area of Science:
- Vascular Surgery
- Health Economics
- Health Policy
Background:
- Medicare reimbursement for inferior vena cava filters (IVCFs) was bundled starting January 1, 2012.
- This change drastically reduced relative value units (RVUs) for IVCF placement procedures.
Purpose of the Study:
- To evaluate the impact of bundled reimbursement on IVCF utilization.
- To determine if IVCF usage decreased following the policy change.
Main Methods:
- Analysis of Medicare limited data sets (5% inpatient, outpatient, carrier files) from 2010-2014.
- Compared IVCF utilization rates before (2010-2011) and after (2012-2014) reimbursement bundling.
- Controlled for deep vein thrombosis (DVT) and pulmonary embolism (PE) diagnoses and placement location.
Main Results:
- IVCF utilization rates per 10,000 DVT/PE diagnoses decreased from an average of 985 (2010-2011) to 823 (2012-2014).
- Statistical analysis revealed a significant decrease (P < 0.0001) in IVCF utilization in 2012, 2013, and 2014 compared to pre-bundling years.
- A significant overall decline in IVCF utilization was observed after the reimbursement bundling.
Conclusions:
- Bundling of IVCF placement reimbursement led to a significant reduction in procedure utilization.
- Further data is required to ascertain the long-term persistence of this decreased utilization trend.
Background:
On January 1, 2012, reimbursement for inferior vena cava filters (IVCFs) became bundled by the Centers for Medicare and Medicaid Services. This resulted in ICVF placement (CPT code 37191) now yielding 4.71 relative value units (RVUs), a decrease from 15.6 RVUs for placement and associated procedures (CPT codes 37620, 36010, 75825-26, 75940-26). Our hypothesis was that IVCF utilization would decrease in response to this change as other procedures had done once they had become bundled.
Methods:
Including data from 2010 to 2011 (before bundling) and 2012 to 2014 (after bundling), we utilized 5% inpatient, outpatient, and carrier files of Medicare limited data sets and analyzed IVCF utilization before and after bundling across specialty types, controlling for total diagnosis of deep vein thrombosis (DVT) and pulmonary embolism (PE) (ICD-9 codes 453.xx and 415.xx, respectively) and placement location.
Results:
In 2010 and 2011, the rates/10,000 DVT/PE diagnoses were 918 and 1,052, respectively (average 985). In 2012, 2013, and 2014, rates were 987, 877, and 605, respectively (average 823). Comparing each year individually, there is a significant difference (P < 0.0001) with 2012, 2013, and 2014 having lower rates of ICVF utilization. Comparing averages in the 2010-2011 and 2012-2014 groups, there is also a significant decrease in utilization after bundling (P < 0.0001).
Conclusions:
Following the bundling of reimbursement for IVCF placement, procedural utilization decreased significantly. More data from subsequent years will be needed to show if this decrease utilization continues to persist.
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