M. J. TerBush1, E. L. Hill1, J. Guido1, A. Doyle1, J. Ellis1, G. R. Morrow1, M. Stoner1, K. Raman1, R. J. Glocker1 1University Of Rochester,Surgery,Rochester, NY, USA
Introduction: On January 1, 2012, reimbursement for inferior vena cava filters (IVCF) became bundled by the Centers for Medicare and Medicaid Services (CMS). This resulted in a 70% decrease in RVUs associated with ICVF placement from 15.6 RVUs to 4.71 RVUs. Our hypothesis was that procedural utilization would decrease following this change. We previously performed an analysis which revealed no significant changes in utilization. As new data have become available, we have revised our analysis in an effort to identify practice pattern changes.
Methods: We analyzed data from 2010-2014 using 5% inpatient, outpatient, and carrier files of Medicare limited data sets, analyzing IVCF utilization, controlling for total diagnosis of deep vein thrombosis (DVT) and pulmonary embolism (PE) (ICD – 9 codes 453.xx and 415.xx, respectively).
Results: In 2010 and 2011, the rates per 10,000 DVT/PE diagnoses were 918 and 1052, respectively (average 985). In 2012, 2013, and 2014, rates were 987, 877, and 605, respectively (average 823). The included figure demonstrates these trends graphically across different specialties. 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 between the 2010-2011 and 2012-2014 groups, there is also a significant decrease in utilization after bundling (p<0.0001).
Conclusion: These data demonstrate that adjusted IVCF deployment rates dropped after the introduction of a bundled code with a reduced RVU and professional fee reimbursement value. This correlation may be evidence of a supply-sensitive medical service, and a successful realignment based on procedural valuation. More data from 2015 to present will be needed to show if this decrease in utilization continues to persist today.
