Practice Patterns of Vascular Surgery's "1%".

Area of Science:

• Vascular Surgery
• Health Economics
• Healthcare Policy

Background:

• Growing public and media attention on healthcare spending highlights practice variation and overutilization of costly services.
• A small subset of healthcare providers receive a disproportionately large share of Medicare payments.
• This study investigates payment disparities among vascular surgeons.

Purpose of the Study:

• To analyze Medicare payment variations among vascular surgeons.
• To compare the practice patterns of the highest-reimbursed vascular surgeons with their peers.

Main Methods:

• Utilized 2016 Medicare Provider Utilization Data, identifying vascular surgeons by National Provider Identification taxonomy.
• Stratified commonly performed procedures into categories (endovascular, open surgery, etc.).
• Compared practice patterns of the top 1% of Medicare-paid vascular surgeons (n=31) against the remaining 99% (n=3,104).

Main Results:

• In 2016, Medicare payments to vascular surgeons totaled $589 million.
• The top 1% of vascular surgeons (31 individuals) received $91 million (15% of total payments).
• The top 1% had significantly different practice patterns (P < 0.05), with endovascular procedures comprising 85% of their reimbursement, including 49% of total atherectomy payments, predominantly in outpatient settings.

Conclusions:

• A small fraction of vascular surgeons accrue a substantial portion of Medicare payments for the specialty.
• Discrepancies stem from differences in procedure volume, utilization rates, and service location.
• The high utilization of outpatient atherectomy by a few providers raises concerns about appropriateness and potential overutilization, necessitating discussions on self-regulation.