title: Utilization of lower extremity arterial disease diagnostic and revascularization procedures in Medicare beneficiaries 2000-2007.
abstract: OBJECTIVE
  The recent escalation in lower extremity revascularization procedures suggests a concomitant increase in peripheral arterial disease (PAD) screening. We hypothesized that self-referring physicians would show the greatest growth in noninvasive physiologic testing for PAD and similar trends for revascularization procedures. We compared utilization rates for self-referring specialties (vascular surgery, interventional radiology, and cardiology) with the utilization rate for a referral-based specialty (diagnostic radiology), assuming the latter to be "basal"--that is, responsive only to changes in demographics and medical knowledge.
  
  
  METHODS
  We analyzed 100% procedure-specific claims for services provided to Medicare Part B beneficiaries during 6 years over an 8-year span (2000-2007). We extracted all Current Procedural Terminology codes for lower extremity vascular noninvasive physiologic studies, peripheral arterial stent placement, and transluminal angioplasty. Utilization volumes were adjusted per 100,000 beneficiaries. Compound annual growth rates were calculated.
  
  
  RESULTS
  Utilization of both noninvasive physiologic and revascularization services increased steadily over the study period. Growth rates of diagnostic services provided by interventional radiologists (7%) and vascular surgeons (8%) were slightly higher than the basal rate (7%), with cardiologists (14%) at the top of the list. For revascularization procedures, vascular surgery showed the greatest growth (28%), a rate more than twice that of cardiology (13%); radiology experienced a decrease in volumes (-2%).
  
  
  CONCLUSIONS
  Self-referring specialists are screening large volumes of Medicare beneficiaries for lower extremity PAD at an accelerated rate compared with testing done by those who do not self-refer. Similar trends exist for endovascular interventions.
authors.affiliation: Department of Diagnostic Imaging, Rhode Island Hospital/Brown University, Providence, RI, USA.
authors.forename: Tyler James
authors.initials: TJ
authors.lastname: Harris
authors.forename: Abdul Mueed
authors.initials: AM
authors.lastname: Zafar
authors.forename: Timothy P
authors.initials: TP
authors.lastname: Murphy
mesh_terms: D039702:Current Procedural Terminology; D003952:Diagnostic Imaging / Q000706:statistics & numerical data*; D057510:Endovascular Procedures / Q000706:statistics & numerical data*; D006801:Humans; D035002:Lower Extremity / Q000098:blood supply*; D016345:Medicare Part B; D008511:Medicine / Q000706:statistics & numerical data*; D058729:Peripheral Arterial Disease / Q000175:diagnosis* / Q000628:therapy*; D018584:Physician Self-Referral / Q000706:statistics & numerical data*; D015607:Stents / Q000706:statistics & numerical data*; D014481:United States