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Abstract 152: Variation in Use, Costs, and Hospital Profitability for Outpatient Interventional Procedures using Vascular Closure Devices: A Descriptive Analysis


 Objective:
 To describe the patterns of care and costs associated with vascular closure device (VCD) use in interventional cardiology and peripheral vascular interventions in hospital outpatient departments from a Medicare perspective.
 
 
 Methods:
 Medicare outpatient use of vascular closure devices was identified using Health Care Procedure Coding System (HCPCS) code C1760 billed by hospitals during 2010 and found in Medicare’s Outpatient Prospective Payment System (OPPS) Limited Data Set (LDS). Hospital volumes, charges, costs, and reimbursements were summarized by hospital and by Hospital Referral Region (HRR) as defined by the Dartmouth Atlas of Health Care. Hospital contribution margins (profitability) for procedures using vascular closure devices were calculated as well.
 
 
 Results:
 We found a total of 272,589 vascular closure devices billed for both interventional cardiology procedures (75%, 205,612 of 272,589) and peripheral vascular interventions (25%, 66,977 of 272,589). The rate of vascular closure device usage was higher among diagnostic and therapeutic interventional cardiology procedures than peripheral vascular procedures (34%, 205,612 of 604,322 versus 24%, 66,977 of 277,342). Total vascular closure device costs billed to Medicare in outpatient hospital settings were $82.1 million. Average device cost per procedure was around $300. The top 5 hospitals for VCD use were different for interventional cardiology versus peripheral interventions. Additionally, the top 5 hospitals that used VCDs for interventional cardiology procedures were primarily due to diagnostic catheterizations and not interventions.
 
 
 Conclusions:
 Frequent users (hospitals) of VCDs seem to be associated with diagnostic use as opposed to interventional use. VCDs are more widely used with cardiovascular procedures versus peripheral procedures. There is significant variation in VCD use across the country, seemingly unrelated to total interventional procedure volume.
 
 
 
