title: Enteral Access Procedures: An 18-Year Analysis of Changing Patterns of Utilization in the Medicare Population.
abstract: OBJECTIVE
  To evaluate national trends in enteral access and maintenance procedures for Medicare beneficiaries with regard to utilization rates, specialty group roles, and sites of service.
  
  
  METHODS
  Using Medicare Physician Supplier Procedure Summary Master Files for the period 1994-2012, claims for gastrostomy and gastrojejunostomy access and maintenance procedures were identified. Longitudinal utilization rates were calculated using annual enrollment data. Procedure volumes by site of service and medical specialty were analyzed.
  
  
  RESULTS
  Between 1994 and 2012, de novo enteral access procedure utilization decreased from 61.6 to 42.3 per 10,000 Medicare Part B beneficiaries (-31%). Gastroenterologists and surgeons performed > 80% of procedures (unchanged over study period) with 97% in the hospital setting. Over time, relative use of an endoscopic approach (62% in 1994; 82% in 2012) increased as percutaneous (21% to 12%) and open surgical (17% to 5%) procedures declined. Existing enteral access maintenance services increased 29% (from 20.1 to 25.9 per 10,000 beneficiaries). Radiologists (from 13% to 31%) surpassed gastroenterologists (from 36% to 21%) as dominant providers of maintenance procedures. Emergency physicians (from 8% to 23%) and nonphysician providers (from 0% to 6%) have seen rapid growth as maintenance services providers as these services have transitioned increasingly to the emergency department setting (from 18% to 32%).
  
  
  CONCLUSIONS
  Among Medicare beneficiaries, de novo enteral access procedures have declined in the last 2 decades as existing access maintenance services have increased. The latter are increasingly performed by radiologists, emergency physicians, and nonphysician providers.
authors.affiliation: Department of Radiology , Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania. Electronic address: Wenshuai.Wan@gmail.com.
authors.forename: Wenshuai
authors.initials: W
authors.lastname: Wan
authors.affiliation: Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia.
authors.forename: C Matthew
authors.initials: CM
authors.lastname: Hawkins
authors.affiliation: Harvey L. Neiman Health Policy Institute, Reston, Virginia.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Hemingway
authors.affiliation: Harvey L. Neiman Health Policy Institute, Reston, Virginia; Department of Health Administration and Policy, George Mason University, Fairfax, Virginia.
authors.forename: Danny
authors.initials: D
authors.lastname: Hughes
authors.affiliation: Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia.
authors.forename: Richard
authors.initials: R
authors.lastname: Duszak
mesh_terms: D000067575:Administrative Claims, Healthcare; D016208:Databases, Factual; D004636:Emergency Service, Hospital / Q000639:trends; D016099:Endoscopy, Gastrointestinal / Q000706:statistics & numerical data / Q000639:trends*; D004750:Enteral Nutrition / Q000706:statistics & numerical data / Q000639:trends*; D015390:Gastric Bypass / Q000706:statistics & numerical data / Q000639:trends*; D000072102:Gastroenterologists / Q000639:trends; D005774:Gastrostomy / Q000706:statistics & numerical data / Q000639:trends*; D006801:Humans; D006278:Medicare / Q000706:statistics & numerical data / Q000639:trends*; D010818:Practice Patterns, Physicians' / Q000639:trends*; D017064:Process Assessment, Health Care / Q000639:trends*; D015641:Radiography, Interventional / Q000706:statistics & numerical data / Q000639:trends*; D000072177:Radiologists / Q000639:trends; D066231:Surgeons / Q000639:trends; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States