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Cardiologists expand turf in peripheral vascular interventions. (Study of Medicare Data).

CHICAGO -- Performance of peripheral angioplasty and stent interventions by radiologists and cardiologists increased by 180% between 1996 and 2000, Dr. Eric Rubin reported at the annual meeting of the Radiological Society of North America.

An analysis of Medicare data shows that radiologists continued to perform the largest number of vascular interventions peripheral to the heart, carotid arteries, and brain--such as stent placement, angioplasty, and thrombolysis--but cardiologists are quickly expanding their share of the market for these procedures, reported Dr. Rubin, a fourth-year resident in diagnostic radiology at Thomas Jefferson University Hospital, Philadelphia.

The findings suggest that if you are going to refer a patient for a peripheral vascular intervention, "make sure you refer to the person who is the best trained," Dr. David Levin, former chairman of radiology at Thomas Jefferson University Hospital, said in an interview at the meeting.

"Find out whether it's your radiologist, cardiologist, or vascular surgeon who is the best-trained individual to do these procedures," advised Dr. Levin, a coinvestigator of the study, who is now medical director of a radiology management company based in Houston, Tex. "The problem is, there are a lot of cardiologists and vascular surgeons getting into this field who have no training."

Investigators used Medicare databases to calculate the total use rates per 100,000 for 10 OPT codes pertinent to peripheral angioplasty and stent interventions between 1996 and 2000. Use rates also were calculated separately for radiologists and cardiologists. Only non-HMO, fee-for-service Medicare Part B beneficiaries were included.

Peripheral vascular interventions were defined as arterial interventions in the legs, arms, abdomen, and pelvis, such as stent placement, angioplasty, and thrombolysis. This category excluded carotid, brain, and cardiac interventions.

The total use of all peripheral arterial interventions increased from 217 to 416 per 100,000 Medicare beneficiaries over the 5-year period, an increase of 180%.

The use of percutaneous peripheral angioplasty and stent placement increased 138% among cardiologists and 57% among radiologists. The use of peripheral stent placement increased 236% among cardiologists and 139% among radiologists, while the use of angioplasty increased 88% among cardiologists and 38% among radiologists, Dr. Rubin reported.

Percutaneous interventions involved the use of needles, catheters, stents, and balloons to accomplish tasks that previously had required open surgical interventions in the operating room.

In addition, the use of renal/visceral arterial angioplasties among cardiologists rose 229% between 1996 and 2000, while the use of those procedures among radiologists rose 54% over the same time period. Renal/visceral angioplasty referred to balloon dilatation of major abdominal arteries emanating from the aorta, such as the celiac axis, superior mesenteric artery, inferior mesenteric artery, and renal arteries.

Although radiologists clearly lead other specialists in the actual number of peripheral vascular interventions performed, Dr. Rubin noted, they have lost 11% of the procedures to cardiologists and other specialists. At the same time, cardiologists had a 6% increase in their share of total interventions.

"Overall, radiologists still have the most experience with noncoronary arterial interventions," he said. "Cardiologists, however, are well entrenched and are rapidly expanding their turf."
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Author:Brunk, Doug
Publication:Internal Medicine News
Date:May 1, 2003
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