Regional and specialty-specific Medicare reimbursement trends in open and endovascular dialysis access interventions.

Abstract

Medicare Part B reimbursements continue to decline annually at the national level. The majority of dialysis patients qualify for Medicare regardless of their age. The objective of this study was to characterize Medicare reimbursement trends for open and endovascular dialysis access interventions stratified based on the geographic region and physician specialty. The 2019-2023 Medicare Physician and Other Practitioners by Provider and Service data set was queried for open and endovascular procedures, including arteriovenous fistula or graft creations and endovascular maintenance/interventions. Weighted mean reimbursements were calculated. The data were stratified by practice setting (facility vs nonfacility), Centers for Medicare and Medicaid Services region, and physician specialty. All nonfacility analyses included only endovascular procedures. For open procedures, percentage changes in reimbursements were compared between vascular surgery and transplant/general surgery. For endovascular procedures, comparisons were made among vascular surgery, radiology, and nephrology. All monetary values were adjusted to the 2023 US dollars. In facility settings, the reimbursements declined across all regions. For open procedures, regions 7 (Central) and 3 (Mid-Atlantic) demonstrated the largest declines at -30% and -24%, respectively. For endovascular procedures, all regions showed similar decreases in reimbursement, ranging from -20% to -29%. In nonfacility locations, the average reimbursement declined in every region, with regions 8 (Mountain West) and 10 (Pacific Northwest) having the largest decreases at -46% and -40%, respectively. Facility reimbursements decreased by an average of -27.3%. Cephalic vein transposition (-22%) and basilic vein transposition (-18%) had the largest decreases with regard to open procedures. Facility-based endovascular procedures, including diagnostic fistulagram, angioplasty, stenting, and thrombectomy, demonstrated similar decreases in reimbursement, ranging from -20% to -22%. In nonfacility settings, the average reimbursement declined by -27%, with central venous angioplasty (-32%) and peripheral dialysis stent (-33%) having the largest declines. Overall, all specialties experienced a similar decrease in reimbursements for both open (P = .12) and endovascular (P = .35) interventions. Our analysis of dialysis access procedures billed to Medicare Part B from 2019 to 2023 demonstrated a continued decline in reimbursements regardless of physician specialty. Regional reimbursement patterns demonstrate decreased reimbursements across the board, with certain regions being disproportionately affected, including regions 7 (Central) and 3 (Mid-Atlantic) for open facility procedures and regions 8 (Mountain West) and 10 (Pacific Northwest) for endovascular nonfacility interventions.