title: Central venous access: evolving roles of radiology and other specialties nationally over two decades.
abstract: OBJECTIVE
  The aim of this study was to evaluate national trends in central venous access (CVA) procedures over 2 decades with regard to changing specialty group roles and places of service.
  
  
  METHODS
  Aggregated claims data for temporary central venous catheter and long-term CVA device (CVAD) procedures were extracted from Medicare Physician/Supplier Procedure Summary Master Files from 1992 through 2011. Central venous catheter and CVAD procedure volumes by specialty group and place of service were studied.
  
  
  RESULTS
  Between 1992 and 2011, temporary and long-term CVA placement procedures increased from 638,703 to 808,071 (+27%) and from 76,444 to 316,042 (+313%), respectively. For temporary central venous catheters, radiology (from 0.4% in 1992 to 32.6% in 2011) now exceeds anesthesiology (from 37% to 22%) and surgery (from 30.4% to 11.7%) as the dominant provider group. Surgery continues to dominate in placement and explantation of long-term CVADs (from 80.7% to 50.4% and from 81.6% to 47.7%, respectively), but radiology's share has grown enormously (from 0.7% to 37.6% and from 0.2% to 28.6%). Although volumes remain small (<10% of all procedures), midlevel practitioners have experienced >100-fold growth for most services. The inpatient hospital remains the dominant site for temporary CVA procedures (90.0% in 1992 and 81.2% in 2011), but the placement of long-term CVADs has shifted from the inpatient (from 68.9% to 45.2%) to hospital outpatient (from 26.9% to 44.3%) setting. In all hospital settings combined, radiologists place approximately half of all tunneled catheters and three-quarters all peripherally inserted central catheters.
  
  
  CONCLUSIONS
  Over the past 2 decades, CVA procedures on Medicare beneficiaries have increased considerably. Radiology is now the dominant overall provider.
authors.affiliation: Harvey L. Neiman Health Policy Institute, Reston, Virginia 20191, USA. rduszak@neimanhpi.org
authors.forename: Richard
authors.initials: R
authors.lastname: Duszak
authors.forename: Nadia
authors.initials: N
authors.lastname: Bilal
authors.forename: Daniel
authors.initials: D
authors.lastname: Picus
authors.forename: Danny R
authors.initials: DR
authors.lastname: Hughes
authors.forename: Baogang J
authors.initials: BJ
authors.lastname: Xu
mesh_terms: D002405:Catheterization, Central Venous / Q000191:economics / Q000706:statistics & numerical data*; D062905:Central Venous Catheters / Q000191:economics / Q000706:statistics & numerical data*; D039702:Current Procedural Terminology; D006801:Humans; D006278:Medicare / Q000191:economics / Q000706:statistics & numerical data*; D015642:Radiology, Interventional / Q000191:economics / Q000706:statistics & numerical data*; D014481:United States; D014600:Utilization Review
keywords: Medicare master files; Radiology and radiologists; central venous access procedures; medical economics; procedure utilization; socioeconomic trends