Transcatheter atrial septal defects and patent foramen ovale closure: Medicare utilization and reimbursements

The Food and Drug Administration has approved percutaneous atrial septal defect (ASD) and patent foramen ovale (PFO) closure devices for hemodynamically significant interatrial shunts, paradoxical emboli including stroke, and decompression sickness. We aimed to study the trends in utilization and reimbursements of transcatheter ASD/PFO closure devices.

To analyze trends in utilization and Medicare reimbursements for transcatheter ASD/PFO closure procedures from 2013 to 2022.

A query of administrative data on United States Medicare beneficiaries undergoing transcatheter ASD/PFO was conducted from 2013 to 2022 using the Centers for Medicare and Medicaid Services Part B National Summary Data File. Inflation adjustments were made using the 2023 Consumer Price Index. Trend analysis was quantified using growth rate and simple linear regression calculations. All analyses were performed using Microsoft Excel 16.77.1 (2023).

The annual number of transcatheter ASD/PFO closure procedures increased by 81% since 2013, with an average yearly growth rate of 44% cases per year (P < 0.001). Annual Medicare reimbursements for transcatheter ASD/PFO therapies mirrored the annual procedure trends. The per-case reimbursements decreased by 18%, i.e., $1128.80 in 2013 and $ 770.21 in 2022 (P < 0.001). There was a significant drop in the number of procedures in the year 2020, which correlates to the onset of the coronavirus disease 2019 pandemic, followed by a sharp uptick in the number of cases in 2021 and 2022.

Medicare utilization of transcatheter ASD/PFO closure therapies has grown significantly in procedural volume from 2013 to 2022. However, this has been accompanied by a decrease in per-case reimbursements.