3:27 PM Abstract No. 45 Evolution in National Endovascular Management of Femoral-Popliteal Artery Disease: an Analysis of the 2011 to 2017 Medicare Data

Multiple studies published over the past decade support an endovascular-first approach to management of femoral-popliteal artery disease. Data supporting use of drug-coated balloon angioplasty, atherectomy and stenting have grown in concert. We sought to describe national trends in utilization of each intervention by provider specialty and clinical setting. The Medicare Physician/Supplier Procedure Summary files containing 100% part B claims were interrogated for years 2011-2017. Current procedural terminology (CPT) codes specific for angioplasty-only (PTA), stenting, and atherectomy were used to create summary statistics for utilization by (1) year, (2) clinical setting (hospital inpatient, hospital outpatient, office-based labs), and (3) provider specialty (cardiology, radiology, surgery). All annual frequency data were normalized to 100,000 Medicare fee-for-service person-years. Atherectomy use increased substantially from 34,732/32.8% services in 2011 to 68,633/50.4% services in 2017 and is now the dominant treatment strategy for femoral-popliteal disease. Relative utilization of stenting (36,792/34.7% in 2011 vs. 29,511/21.7% in 2017) and angioplasty-only (34,398/32.5% in 2011 vs. 37,945/27.9% in 2017) decreased concomitantly. Atherectomy use was two-fold higher in the office compared with the outpatient hospital setting (83% OBL vs. 40% outpatient hospital in 2017). Treatment strategy varied by provider specialty in 2011 when cardiologists used atherectomy most frequently (17,925/42.9%), while radiologists used angioplasty-only (5928/45.7%) and surgeons stented (17,648 / 35.9%) most frequently. However, by 2017 all specialties utilized atherectomy most frequently (58.2% for cardiology, 49.7% for radiology, and 44.7% for surgery). National approach to endovascular management of femoral-popliteal artery disease has evolved since 2011, with physicians now favoring an implant-free strategy fueled primarily by a multifold increase in atherectomy use. Discordant rates of atherectomy use between the ambulatory and office setting raise the specter of potential billing abuse.