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Abstract
Background
Atherectomy has become the fastest growing catheter‐based peripheral vascular intervention performed in the United States, and overuse has been linked to increased reimbursement, but the patterns of use have not been well characterized.
Methods and Results
We used Blue Cross Blue Shield of Michigan Preferred Provider Organization and Medicare fee‐for‐service professional claims data from the Michigan Value Collaborative for patients undergoing office‐based laboratory atherectomy in 2019 to calculate provider‐specific rates of atherectomy use, reimbursement, number of vessels treated, and number of atherectomies per patient. We also calculated the rate that each provider converted a new patient visit to an endovascular procedure within 90 days. Correlations between parameters were assessed with simple linear regression. Providers completing ≥20 office‐based laboratory atherectomies and ≥20 new patient evaluations during the study period were included. A total of 59 providers performing 4060 office‐based laboratory atherectomies were included. Median professional reimbursement per procedure was $4671.56 (interquartile range [IQR], $2403.09–$7723.19) from Blue Cross Blue Shield of Michigan and $14 854.49 (IQR, $9414.80–$18 816.33) from Medicare, whereas total professional reimbursement from both payers ranged from $2452 to $6 880 402 per year. Median 90‐day conversion rate was 5.0% (IQR, 2.5%–10.0%), whereas the median provider‐level average number of vessels treated per patient was 1.20 (IQR, 1.13–1.31) and the median provider‐level average number of treatments per patient was 1.38 (IQR, 1.26–1.63). Total annual reimbursement for each provider was directly correlated with new patient‐procedure conversion rate (
R
2
=0.47;
P
<0.001), mean number of vessels treated per patient (
R
2
=0.31;
P
<0.001), and mean number of treatments per patient (
R
2
=0.33;
P
<0.001).
Conclusions
A minority of providers perform most procedures and are reimbursed substantially more per procedure compared with most providers. Procedural conversion rate, number of vessels, and number of treatments per patient represent potential policy levers to curb overuse.
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Affiliation(s)
- Craig S. Brown
- Section of General Surgery, Department of Surgery University of Michigan Ann Arbor MI
- Center for Healthcare Outcomes and Policy Institute for Healthcare Policy and Innovation University of Michigan Ann Arbor MI
| | - Ryan E. Eton
- Section of General Surgery, Department of Surgery University of Michigan Ann Arbor MI
- Center for Healthcare Outcomes and Policy Institute for Healthcare Policy and Innovation University of Michigan Ann Arbor MI
| | - Jessica M. Yaser
- Center for Healthcare Outcomes and Policy Institute for Healthcare Policy and Innovation University of Michigan Ann Arbor MI
| | - John D. Syrjamaki
- Center for Healthcare Outcomes and Policy Institute for Healthcare Policy and Innovation University of Michigan Ann Arbor MI
| | - Matthew A. Corriere
- Center for Healthcare Outcomes and Policy Institute for Healthcare Policy and Innovation University of Michigan Ann Arbor MI
- Section of Vascular Surgery, Department of Surgery University of Michigan Ann Arbor MI
| | - Peter K. Henke
- Section of Vascular Surgery, Department of Surgery University of Michigan Ann Arbor MI
| | - Michael J. Englesbe
- Section of General Surgery, Department of Surgery University of Michigan Ann Arbor MI
- Center for Healthcare Outcomes and Policy Institute for Healthcare Policy and Innovation University of Michigan Ann Arbor MI
| | - Nicholas H. Osborne
- Center for Healthcare Outcomes and Policy Institute for Healthcare Policy and Innovation University of Michigan Ann Arbor MI
- Section of Vascular Surgery, Department of Surgery University of Michigan Ann Arbor MI
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2
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Eton RE, Schaefer SL, Englesbe MJ. Regional Variation in Pediatric Deceased Organ Donation Consent Rates Is Costing Lives. Pediatrics 2021; 147:peds.2021-050048. [PMID: 33963075 DOI: 10.1542/peds.2021-050048] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/25/2021] [Indexed: 11/24/2022] Open
Affiliation(s)
- Ryan E Eton
- Department of Surgery, Michigan Medicine, Ann Arbor, Michigan
| | - Sara L Schaefer
- Department of Surgery, Michigan Medicine, Ann Arbor, Michigan
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4
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Brown CS, Eton RE, Corriere MA, Henke PK, Englesbe MJ, Osborne NH. Using Payment Incentives to Decrease Atherectomy Overutilization. Ann Vasc Surg 2021; 73:144-146. [PMID: 33485907 DOI: 10.1016/j.avsg.2021.01.061] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Revised: 01/10/2021] [Accepted: 01/14/2021] [Indexed: 11/19/2022]
Affiliation(s)
- Craig S Brown
- Department of Surgery, University of Michigan, Ann Arbor, MI; Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor, MI.
| | - Ryan E Eton
- Department of Surgery, University of Michigan, Ann Arbor, MI; Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor, MI
| | - Matthew A Corriere
- Department of Surgery, University of Michigan, Ann Arbor, MI; Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor, MI
| | - Peter K Henke
- Department of Surgery, University of Michigan, Ann Arbor, MI; Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor, MI
| | - Michael J Englesbe
- Department of Surgery, University of Michigan, Ann Arbor, MI; Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor, MI
| | - Nicholas H Osborne
- Department of Surgery, University of Michigan, Ann Arbor, MI; Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor, MI
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5
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Bhumiratana S, Bernhard JC, Alfi DM, Yeager K, Eton RE, Bova J, Shah F, Gimble JM, Lopez MJ, Eisig SB, Vunjak-Novakovic G. Tissue-engineered autologous grafts for facial bone reconstruction. Sci Transl Med 2017; 8:343ra83. [PMID: 27306665 DOI: 10.1126/scitranslmed.aad5904] [Citation(s) in RCA: 146] [Impact Index Per Article: 20.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2015] [Accepted: 04/27/2016] [Indexed: 12/17/2022]
Abstract
Facial deformities require precise reconstruction of the appearance and function of the original tissue. The current standard of care-the use of bone harvested from another region in the body-has major limitations, including pain and comorbidities associated with surgery. We have engineered one of the most geometrically complex facial bones by using autologous stromal/stem cells, native bovine bone matrix, and a perfusion bioreactor for the growth and transport of living grafts, without bone morphogenetic proteins. The ramus-condyle unit, the most eminent load-bearing bone in the skull, was reconstructed using an image-guided personalized approach in skeletally mature Yucatán minipigs (human-scale preclinical model). We used clinically approved decellularized bovine trabecular bone as a scaffolding material and crafted it into an anatomically correct shape using image-guided micromilling to fit the defect. Autologous adipose-derived stromal/stem cells were seeded into the scaffold and cultured in perfusion for 3 weeks in a specialized bioreactor to form immature bone tissue. Six months after implantation, the engineered grafts maintained their anatomical structure, integrated with native tissues, and generated greater volume of new bone and greater vascular infiltration than either nonseeded anatomical scaffolds or untreated defects. This translational study demonstrates feasibility of facial bone reconstruction using autologous, anatomically shaped, living grafts formed in vitro, and presents a platform for personalized bone tissue engineering.
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Affiliation(s)
- Sarindr Bhumiratana
- Department of Biomedical Engineering, Columbia University, 500 West 120th Street, New York, NY 10027, USA
| | - Jonathan C Bernhard
- Department of Biomedical Engineering, Columbia University, 500 West 120th Street, New York, NY 10027, USA
| | - David M Alfi
- Division of Oral and Maxillofacial Surgery, Columbia University College of Dental Medicine, 630 West 168th Street, New York, NY 10032, USA
| | - Keith Yeager
- Department of Biomedical Engineering, Columbia University, 500 West 120th Street, New York, NY 10027, USA
| | - Ryan E Eton
- Department of Biomedical Engineering, Columbia University, 500 West 120th Street, New York, NY 10027, USA
| | - Jonathan Bova
- School of Veterinary Medicine, Louisiana State University, Skip Bertman Drive, Baton Rouge, LA 70803, USA
| | - Forum Shah
- LaCell LLC, 1441 Canal Street, New Orleans, LA 70112, USA
| | - Jeffrey M Gimble
- LaCell LLC, 1441 Canal Street, New Orleans, LA 70112, USA. Center for Stem Cell Research and Regenerative Medicine, Tulane University School of Medicine, 1324 Tulane Avenue, SL-99, New Orleans, LA 70112, USA
| | - Mandi J Lopez
- School of Veterinary Medicine, Louisiana State University, Skip Bertman Drive, Baton Rouge, LA 70803, USA
| | - Sidney B Eisig
- Division of Oral and Maxillofacial Surgery, Columbia University College of Dental Medicine, 630 West 168th Street, New York, NY 10032, USA
| | - Gordana Vunjak-Novakovic
- Department of Biomedical Engineering, Columbia University, 500 West 120th Street, New York, NY 10027, USA.
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