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Rise in chronic venous insufficiency procedures


The use of procedures to treat chronic venous insufficiency in Medicare patients increased markedly from 2005 through 2014, according to a study in Journal of Vascular and Interventional Radiology.

New Research Finds Substantial Increase in Chronic Venous Insufficiency Procedures in Medicare Population

Reston, VA – A new study by the Harvey L. Neiman Health Policy Institute found that utilization of procedures to treat chronic venous insufficiency (CVI) in the Medicare population increased markedly from 2005 through 2014. The study is published online in the Journal of Vascular and Interventional Radiology (JVIR).

The researchers used aggregated Centers for Medicare and Medicaid Services claims data to identify recent temporal trends in the use of CVI treatment procedures in the Medicare population, with attention to conventional versus new minimally invasive procedures, as well as performance by site of service and physician specialty.

“We discovered that between 2005 and 2014, total services for CVI in the Medicare fee-for-service population grew from 95,206 to 332,244,” said Neiman Institute affiliate research fellow and lead study author Anand M. Prabhakar, MD, MBA.

Prabhakar and his colleagues found that procedure growth was particularly rapid for newer minimally invasive procedures, including radiofrequency (RF) and laser ablation.  RF ablation utilization per 1,000 Medicare enrollees increased the most from 0.3 in 2005 to 2.6 in 2013. CVI procedure services were predominantly performed in the private office setting. The percentage of procedures performed annually in the office setting increased annually from 87 percent in 2005 to 92 percent in 2014.

As a group, vascular surgeons and other surgeons were the dominant providers of these services, with relative market shares of 33 percent and 29 percent, respectively, in 2005, to 26 percent and 25 percent in 2014. Although radiologists and cardiologists had smaller market shares, their relative growth was much faster, with compound annual growth rates of 23 percent for radiology and 51percent for cardiology versus 12 percent for vascular surgery and 13 percent for other surgery.

“As a group, cardiology experienced the most rapid growth in market share from 2005 to 2014 for all CVI procedures, far outpacing that of radiology, vascular surgery, other surgery, and primary care providers,” noted Prabhakar. “For interventional radiology to play a more prominent role, it is critical that trainees learn how to run a consultative practice, including how to evaluate and manage patients with CVI.”

“Our results show that a number of different specialists are currently performing a wide mix of procedures for this clinical condition,” added Richard Duszak, MD, FACR, professor and vice chair for health policy and practice in the department of radiology and imaging sciences at Emory University and senior affiliate research fellow at the Neiman Institute. “The findings now serve as a foundation for future work to systematically compare quality and patient outcomes associated with the various procedures and performing specialists to help shape policy and practice patterns to optimize patient care.”

To obtain a copy of the JVIR study or to arrange an interview with a Neiman Institute spokesperson, contact Nicole Racadag at (703) 716-7559 or nracadag@neimanhpi.org.


About the Harvey L. Neiman Health Policy Institute
The Harvey L. Neiman Health Policy Institute is one of the nation’s leading medical imaging socioeconomic research organizations. The Neiman Institute studies the role and value of radiology and radiologists in evolving health care delivery and payment systems and the impact of medical imaging on the cost, quality, safety and efficiency of health care. Visit us at www.neimanhpi.org and follow us on TwitterLinkedIn and Facebook.


Changing Medicare Utilization of Minimally Invasive Procedures for the Treatment of Chronic Venous Insufficiency



To examine changes in the utilization of procedures related to treatment of chronic venous insufficiency (CVI) in the Medicare population.

Materials and Methods

Service-specific claims data for phlebectomy, sclerotherapy, and radiofrequency (RF) and laser ablation were identified by using Medicare Physician Supplier Procedure Summary master files from 2005 through 2014. Longitudinal national utilization rates were calculated by using annual Medicare enrollment data from 2005 through 2013. Procedure volumes by specialty group and site of service were analyzed.


Total annual claims for these procedures in the Medicare fee-for-service beneficiaries increased from 95,206 to 332,244 (Compound Annual Growth Rate [CAGR], 15%) between 2005 and 2014. Per 1,000 beneficiaries, overall utilization increased annually from 2.8 in 2005 to 9.4 in 2013. Most procedures were performed in the private office setting (92% in 2014). In 2014, radiologists had a 10% relative market share, compared with vascular surgeons, other surgeons, and cardiologists, who had 26%, 25%, and 14% market shares, respectively. Cardiologists had the fastest relative growth, with a CAGR of 51% compared with 23% for radiology, 12% for vascular surgery, and 13% for other surgery. Total venous RF ablation services grew with a CAGR of 31%, with radiology and cardiology growing most rapidly (40% and 79%, respectively). Total venous laser ablation services grew with a CAGR of 22%, with radiology growing 15% and cardiology growing most rapidly at 44%.


Utilization of CVI procedures in the Medicare population increased markedly from 2005 through 2014. The overwhelming majority are performed in the private office setting by nonradiologists.

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