title: Bundling of Reimbursement for Inferior Vena Cava Filter Placement Resulted in Significantly Decreased Utilization between 2012 and 2014.
abstract: BACKGROUND
  On January 1, 2012, reimbursement for inferior vena cava filters (IVCFs) became bundled by the Centers for Medicare and Medicaid Services. This resulted in ICVF placement (CPT code 37191) now yielding 4.71 relative value units (RVUs), a decrease from 15.6 RVUs for placement and associated procedures (CPT codes 37620, 36010, 75825-26, 75940-26). Our hypothesis was that IVCF utilization would decrease in response to this change as other procedures had done once they had become bundled.
  
  
  METHODS
  Including data from 2010 to 2011 (before bundling) and 2012 to 2014 (after bundling), we utilized 5% inpatient, outpatient, and carrier files of Medicare limited data sets and analyzed IVCF utilization before and after bundling across specialty types, controlling for total diagnosis of deep vein thrombosis (DVT) and pulmonary embolism (PE) (ICD-9 codes 453.xx and 415.xx, respectively) and placement location.
  
  
  RESULTS
  In 2010 and 2011, the rates/10,000 DVT/PE diagnoses were 918 and 1,052, respectively (average 985). In 2012, 2013, and 2014, rates were 987, 877, and 605, respectively (average 823). Comparing each year individually, there is a significant difference (P < 0.0001) with 2012, 2013, and 2014 having lower rates of ICVF utilization. Comparing averages in the 2010-2011 and 2012-2014 groups, there is also a significant decrease in utilization after bundling (P < 0.0001).
  
  
  CONCLUSIONS
  Following the bundling of reimbursement for IVCF placement, procedural utilization decreased significantly. More data from subsequent years will be needed to show if this decrease utilization continues to persist.
authors: Department of Surgery, University of Rochester, Rochester, NY. Electronic address: roan_glocker@urmc.rochester.edu.
authors: Roan J
authors: RJ
authors: Glocker
authors: Department of Surgery, University of Rochester, Rochester, NY.
authors: Matthew J
authors: MJ
authors: TerBush
authors: Department of Surgery, University of Rochester, Rochester, NY.
authors: Elaine L
authors: EL
authors: Hill
authors: Department of Surgery, University of Rochester, Rochester, NY.
authors: Joseph J
authors: JJ
authors: Guido
authors: Department of Surgery, University of Rochester, Rochester, NY.
authors: Adam
authors: A
authors: Doyle
authors: Department of Surgery, University of Rochester, Rochester, NY.
authors: Jennifer L
authors: JL
authors: Ellis
authors: Department of Surgery, University of Rochester, Rochester, NY.
authors: Kathleen
authors: K
authors: Raman
authors: Department of Surgery, University of Rochester, Rochester, NY.
authors: Gary R
authors: GR
authors: Morrow
authors: Department of Surgery, University of Rochester, Rochester, NY.
authors: Michael C
authors: MC
authors: Stoner
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D016208:Databases, Factual; D018588:Fee-for-Service Plans / Q000191:economics* / Q000639:trends; D005260:Female; D017048:Health Care Costs / Q000639:trends; D006801:Humans; D008297:Male; D006278:Medicare / Q000191:economics* / Q000706:statistics & numerical data / Q000639:trends; D008875:Middle Aged; D064872:Patient Care Bundles / Q000191:economics* / Q000639:trends; D010818:Practice Patterns, Physicians' / Q000191:economics* / Q000639:trends; D019919:Prosthesis Implantation / Q000191:economics* / Q000295:instrumentation / Q000706:statistics & numerical data / Q000639:trends; D012189:Retrospective Studies; D013997:Time Factors; D014481:United States; D016306:Vena Cava Filters / Q000191:economics* / Q000706:statistics & numerical data