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P3: Plenary Session 3

SS07 - Medicare patients with PAD are treated more quickly but undergo higher cost interventions in OBLs versus outpatient hospital settings

Thursday, June 20, 2024
8:11 AM – 8:22 AM CT
Location: West Building, Level 3, Skyline Ballroom W375ab
Objectives: Controversy exists regarding the value and limitations of different sites of service for peripheral artery disease (PAD) treatment. We aimed to examine patient characteristics and practice patterns associated with peripheral vascular interventions (PVI) performed in the office-based laboratory (OBL) vs. outpatient hospital setting using a nationally representative database.

Methods: Using 100% Medicare fee-for-service claims data that identified all patients undergoing PVI for claudication or chronic limb-threatening ischemia (CLTI) between 01/2017 and 12/2022, we evaluated the associations of patient and procedure characteristics with site of service using hierarchical logistic regression. We used multinomial regressions to estimate associations of site of service and procedure type (angioplasty, stent, atherectomy).

Results: Of 848,526 PVIs, 485,942 (57.3%) were performed in an OBL. OBL use increased significantly over time from 48.3% in 2017 to 65.6% in 2022 (P < 0.001; Fig 1). Patients treated in OBLs were more likely to be non-white (aOR 1.14, 95%CI 1.11-1.18), have fewer comorbidities, and more likely to be treated for claudication than CLTI (aOR 1.30, 95%CI 1.27-1.33) compared to patients treated in outpatient hospital settings. The median time from diagnosis to treatment was shorter in OBLs, particularly for patients with CLTI (28 vs. 37 days, P< 0.001). OBL setting was the strongest predictor of patients receiving an atherectomy alone (aIRR 6.54, 95%CI 6.41-6.62) or atherectomy+stent (aIRR 10.42, 95%CI 10.20-10.64), whereas hospital setting was associated with higher likelihood of stenting alone (aIRR 1.45, 95%CI 1.42-1.48) (Fig 2). Average reimbursement (including procedure and facility fees) was greater for OBLs ($8,742/case) compared to the hospital ($7,784/case), a difference that is entirely explained by the higher use of atherectomy in OBL settings.

Conclusions: OBLs offered greater access to care for non-white patients and shorter time to treatment, but more frequently engaged in high-cost interventions compared to the outpatient hospital setting. The benefit to patients from improved access to PAD care in OBL settings must be balanced with the potential limitations of receiving differential care.