title: Percutaneous hepatic and renal biopsy procedures: an 18-year analysis of changing utilization, specialty roles, and sites of service.
abstract: OBJECTIVE
  To evaluate national trends in percutaneous hepatic and renal biopsy procedures with regard to utilization, specialty group roles, and sites of service.
  
  
  METHODS
  Service-specific claims data for percutaneous hepatic and renal biopsy procedures were identified using Medicare Physician Supplier Procedure Summary Master Files for the period 1994-2012. Longitudinal national utilization rates were calculated using annual Medicare enrollment data. Procedure volumes by specialty group and site of service were analyzed.
  
  
  RESULTS
  Between 1994 and 2012, the number of hepatic and renal biopsies performed on Medicare Part B beneficiaries increased 22% (from 43,478 to 53,055) and 68% (19,508 to 32,762), respectively. Per 100,000 beneficiaries, the utilization of hepatic and renal biopsy increased 19.6% (from 134.6 to 161.0) and 69.3% (from 60.4 to 102.2). Procedures performed by radiologists disproportionately increased 81% (from 25,484 to 46,181) and 236% (from 6,855 to 23,003), respectively. Although utilization in the inpatient setting declined 28.7% (from 68.2 to 48.6 per 100,000) for hepatic biopsies and 9.4% (from 43.1 to 39.1) for renal biopsies, there were larger concurrent increases of 73.9% (from 59.2 to 103.0) and 303.9% (from 15.1 to 61.0) in utilization in the outpatient setting.
  
  
  CONCLUSIONS
  Between 1994 and 2012, national utilization of percutaneous hepatic and renal biopsy procedures in the Medicare population increased as services increasingly shifted from the hospital inpatient to outpatient setting. Radiologists are presently and increasingly the dominant providers of both services.
authors.affiliation: Emory University School of Medicine, 1364 Clifton Road NE Ste D112, Atlanta, Georgia 30322. Electronic address: wangel2@emory.edu.
authors.forename: Wesley
authors.initials: W
authors.lastname: Angel
authors.affiliation: Emory University School of Medicine, 1364 Clifton Road NE Ste D112, Atlanta, Georgia 30322.
authors.forename: C Matthew
authors.initials: CM
authors.lastname: Hawkins
authors.affiliation: University of Central Arkansas, Conway, Arkansas.
authors.forename: Jennifer M
authors.initials: JM
authors.lastname: Wang
authors.affiliation: Harvey L. Neiman Health Policy Institute, Washington, DC.
authors.forename: Danny R
authors.initials: DR
authors.lastname: Hughes
authors.affiliation: Emory University School of Medicine, 1364 Clifton Road NE Ste D112, Atlanta, Georgia 30322; Harvey L. Neiman Health Policy Institute, Washington, DC.
authors.forename: Richard
authors.initials: R
authors.lastname: Duszak
mesh_terms: D001706:Biopsy / Q000379:methods* / Q000706:statistics & numerical data / Q000639:trends; D006801:Humans; D007668:Kidney / Q000473:pathology*; D008099:Liver / Q000473:pathology*; D006278:Medicare; D011871:Radiology; D014481:United States