Evolving roles of radiologists, nephrologists, and surgeons in endovascular hemodialysis access maintenance procedures.
OBJECTIVE
The aim of this study was to evaluate the changing relative roles of radiologists, nephrologists, and surgeons performing endovascular hemodialysis access maintenance procedures.


METHODS
Medicare Physician Supplier Procedure Summary Master Files from 2001 through 2008 were analyzed for procedure codes for hemodialysis access angiography, angioplasty, percutaneous thrombectomy, and open surgical interventions. Using physician specialty code data, component procedure volume for all 3 endovascular services was extracted for radiologists, nephrologists, and surgeons. Percentage changes were calculated for all groups. National trends in percutaneous and open interventions were compared.


RESULTS
Between 2001 and 2008, the total Medicare fee-for-service component procedure volume for dialysis access angiography, angioplasty, and percutaneous thrombectomy increased by 102%, 171%, and 52%, respectively. In 2008, radiologists performed 50% of angiography, 47% of angioplasty, and 46% of declotting procedures, down from 82%, 82%, and 84%, respectively, in 2001. In contrast, nephrologists increased from 4%, 5%, and 4% to 22%, 27%, and 21% of services, and surgeons increased from 7%, 5%, and 4% to 22%, 19%, and 16%. As percutaneous procedures increased in frequency, open surgical interventions declined by 43%.


CONCLUSIONS
Nationally, endovascular hemodialysis access maintenance procedures have increased as open surgical interventions have declined. Nephrologists and surgeons have both experienced marked relative increases in endovascular procedure volumes as radiologists, previously by far the predominant providers of these services, now only perform approximately half.
Mid-South Imaging and Therapeutics, 6305 Humphreys Boulevard, Memphis, TN 38120, USA. rduszak@duszak.com
Richard
R
Duszak
Laurence
L
Parker
David C
DC
Levin
Vijay M
VM
Rao
D000792:Angiography / Q000639:trends; D017130:Angioplasty / Q000639:trends; D001166:Arteriovenous Shunt, Surgical / Q000639:trends*; D039702:Current Procedural Terminology; D057510:Endovascular Procedures / Q000639:trends*; D018588:Fee-for-Service Plans / Q000191:economics; D013502:General Surgery; D006801:Humans; D007344:Insurance Claim Reporting / Q000706:statistics & numerical data*; D006278:Medicare / Q000191:economics; D009398:Nephrology; D010819:Physician's Role; D010818:Practice Patterns, Physicians' / Q000639:trends*; D011871:Radiology; D006435:Renal Dialysis; D017131:Thrombectomy / Q000639:trends; D014481:United States