Although minimally invasive (endovascular) treatments for patientswith peripheral arterial disease (PAD) result in shorter hospital stays and the potential to save Medicare millions of dollars each year, a new study reveals that thequality of care and cost depend on who's providing the treatment.The study, which appears in this month's Journal of Vascular and Interventional Radiology, is the first and largest study of its kind on these treatments forMedicare patients age 65 and older. "Identifying quality health care and cost savings for treating adisease that affects millions of Americans is critical," saidMarshall Hicks, M.D., FSIR, president-elect of the Society ofInterventional Radiology, a national scientific organization ofnearly 4,700 doctors, scientists and allied health professionalsdedicated to improving health care through minimally invasivetreatments. "This study can help consumers understand thatdifferent doctors get different outcomes for the same treatments -and that they have a choice," said Hicks, an interventionalradiologist and head of the diagnostic imaging division at theUniversity of Texas MD Anderson Cancer Center in Houston. PAD is a common yet dangerous condition that affects an estimated10 million people in the United States (12 percent of Americansover age 65) and can lead to heart attack or stroke . The vascular disease develops mostly as a result ofatherosclerosis or hardening of the arteries, which occurs when cholesterol and scar tissue build up, forming plaque that narrows and clogsthe arteries and slows blood flow to the legs. |
Researchers in the study reviewed Medicare claims data from morethan 14,000 patients with PAD over two years from Medicare'sStandard Analytical Files, which present a large dataset thatcontains all services (physician, inpatient, and outpatient). Theauthors compared outcomes of percutaneous (procedures done throughthe skin) PAD treatments in Medicare patients according to thephysician specialty type (interventional radiologist,interventional cardiologist, vascular surgeon) that provided theservice and assessed mortality, transfusion, intensive care use,length of stay, and subsequent restoration of blood supply oramputation. Outcomes were compared using standard outcomeprediction formulas adjusted for age, gender, race, emergencydepartment admission and other existing conditions. "We found that costs and provider care are not alike," said currentsociety president Timothy P.
Murphy, M.D., FSIR, a study co-author."We noted that the adjusted average one-year procedure cost whenperformed by interventional radiologists was about $17,640. That'sa cost savings to Medicare of approximately $1,000 per procedure -which means that in such a large population, treatments for PAD byinterventional radiologists could potentially save taxpayers $230million each year. And the patient outcomes are better," saidMurphy, an interventional radiologist and director of the VascularDisease Research Center at Rhode Island Hospital in Providence. Murphy noted data from the study provided strong evidence thattreatment by interventional radiologists provides numerous benefitsto the PAD patient, such as less risk of infection, lessanesthesia, less pain and scarring, faster recovery and a quickerreturn to normal activities. "The Medicare data clearly show moretransfusion and intensive care utilization, longer length of stay,more repeat procedures or amputations and higher costs whentreatment is not performed by interventional radiologists," Murphyadded.
PAD is a narrowing of the blood vessels in the leg, which limitsthe supply of oxygen and nutrients to the leg, causing pain anddiscomfort. The first line of defense for peripheral arterialdisease is lifestyle changes, however; when this provesunsuccessful, other techniques including endovascular interventions(minimally invasive treatments where a physician uses imageguidance to thread a very thin tube called a catheter through anartery in the groin to the blockage in the legs) may be performed.Options include using a small balloon or a tiny mesh tube called astent, where the physician can open a blocked artery in a minimallyinvasive way through only a nick in the skin the size of a penciltip. These interventions are performed by interventionalradiologists, as well as by vascular surgeons and interventionalcardiologists. Additional References Citations.
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