RS05 - Regional and Specialty-Specific Medicare Reimbursement Trends in Open and Endovascular Dialysis Access Interventions

Objectives: Medicare Part B reimbursements continue to decline annually at the national level. The majority of dialysis patients qualify for Medicare regardless of their age. Our objective was to characterize Medicare reimbursement trends for open and endovascular dialysis access interventions stratified based on geographic region and physician specialty.

Methods: The 2019-2023 Medicare Physician and Other Practitioners by Provider and Service dataset 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 setting (facility vs. non-facility), Centers for Medicare and Medicaid Services region, and physician specialty. All non-facility analyses included only endovascular procedures. For open procedures, percentage change in reimbursements were compared between Vascular Surgery and Transplant/General Surgery. For endovascular procedures, comparison was made between Vascular Surgery, Radiology, and Nephrology. All monetary values were adjusted to the 2023 US dollar.

Results: In facility settings, the reimbursement declined in all regions (Figure). For open procedures, Regions 7 (Central) and 3 (Mid-Atlantic) had the largest decline at -30% and -24%, respectively. For endovascular procedures, all regions had similar decreases in reimbursement, ranging from -20% to -29%. In non-facility 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 on average decreased by -27.3%. Brachiocephalic (-22%) and brachiobasilic (-18%) AVF creation had the largest decreases with regard to open procedures. Facility endovascular procedures including diagnostic fistulogram, angioplasty, stenting, and thrombectomy had similar decreases in reimbursement, ranging from -20 to -22%. In non-facility 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=0.12) and endovascular (p=0.35) interventions.

Conclusions: Our analysis of dialysis access procedures billed to Medicare Part B from 2019 to 2023 shows 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 non-facility interventions.