title: Changing Medicare Utilization of Minimally Invasive Procedures for the Treatment of Chronic Venous Insufficiency.
abstract: OBJECTIVE
  To examine changes in the utilization of procedures related to treatment of chronic venous insufficiency (CVI) in the Medicare population.
  
  
  METHODS
  Service-specific claims data for phlebectomy, sclerotherapy, and radiofrequency (RF) and laser ablation were identified by using Medicare Physician Supplier Procedure Summary master files from 2005 through 2014. Longitudinal national utilization rates were calculated by using annual Medicare enrollment data from 2005 through 2013. Procedure volumes by specialty group and site of service were analyzed.
  
  
  RESULTS
  Total annual claims for these procedures in the Medicare fee-for-service beneficiaries increased from 95,206 to 332,244 (Compound Annual Growth Rate [CAGR], 15%) between 2005 and 2014. Per 1,000 beneficiaries, overall utilization increased annually from 2.8 in 2005 to 9.4 in 2013. Most procedures were performed in the private office setting (92% in 2014). In 2014, radiologists had a 10% relative market share, compared with vascular surgeons, other surgeons, and cardiologists, who had 26%, 25%, and 14% market shares, respectively. Cardiologists had the fastest relative growth, with a CAGR of 51% compared with 23% for radiology, 12% for vascular surgery, and 13% for other surgery. Total venous RF ablation services grew with a CAGR of 31%, with radiology and cardiology growing most rapidly (40% and 79%, respectively). Total venous laser ablation services grew with a CAGR of 22%, with radiology growing 15% and cardiology growing most rapidly at 44%.
  
  
  CONCLUSIONS
  Utilization of CVI procedures in the Medicare population increased markedly from 2005 through 2014. The overwhelming majority are performed in the private office setting by nonradiologists.
authors.affiliation: Department of Radiology, Division of Cardiovascular Imaging, Harvard Medical School, Massachusetts General Hospital, 55 Fruit St., Gray 2, Boston, MA 02114. Electronic address: aprabhakar@mgh.harvard.edu.
authors.forename: Anand M
authors.initials: AM
authors.lastname: Prabhakar
authors.affiliation: Department of Radiology, Division of Cardiovascular Imaging, Harvard Medical School, Massachusetts General Hospital, 55 Fruit St., Gray 2, Boston, MA 02114.
authors.forename: Alexander S
authors.initials: AS
authors.lastname: Misono
authors.affiliation: Department of Interventional Radiology, University of Texas M.D. Anderson Cancer Center, Houston, Texas.
authors.forename: Rahul A
authors.initials: RA
authors.lastname: Sheth
authors.affiliation: Department of Radiology, New York University Langone Medical Center, New York, New York.
authors.forename: Andrew B
authors.initials: AB
authors.lastname: Rosenkrantz
authors.affiliation: Harvey L. Neiman Health Policy Institute, Washington, DC.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Hemingway
authors.affiliation: Harvey L. Neiman Health Policy Institute, Washington, DC; Department of Health Administration and Policy, George Mason University, Fairfax, Virginia.
authors.forename: Danny R
authors.initials: DR
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: D000368:Aged; D002908:Chronic Disease; D006801:Humans; D006278:Medicare / Q000191:economics*; D019060:Minimally Invasive Surgical Procedures; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D014481:United States; D014656:Vascular Surgical Procedures / Q000191:economics*; D014689:Venous Insufficiency / Q000601:surgery*