Original article
National Fluid Shifts: Fifteen-Year Trends in Paracentesis and Thoracentesis Procedures

https://doi.org/10.1016/j.jacr.2010.04.013Get rights and content

Purpose

The aim of this study was to evaluate national trends in paracentesis and thoracentesis procedures and the relative roles of specialty groups providing these services.

Methods

Medicare Physician Supplier Procedure Summary Master Files from 1993 to 2008 were analyzed for paracentesis and thoracentesis procedure codes. Using physician specialty identifier codes, procedure volumes were extracted for radiologists, primary care physicians, and surgeons for both procedures. Volume data were extracted for gastroenterologists and pulmonary and critical care medicine physicians, respectively, for paracentesis and thoracentesis. Frequency by site of service was similarly evaluated. Relative changes were calculated.

Results

Between 1993 and 2008, paracentesis procedures on Medicare fee-for-service beneficiaries increased by 133% (from 64,371 to 149,699), and thoracentesis procedures decreased by 14% (from 147,363 to 127,444). Services by radiologists increased by 964% (from 10,456 to 111,275) and 358% (from 14,531 to 66,602), respectively, while all other targeted groups experienced declines. For paracentesis, radiologist and gastroenterologist procedure shares changed from 16% and 32%, respectively, in 1993 to 74% and 6% in 2008. For thoracentesis, radiologist and pulmonary and critical care medicine physician shares changed from 10% and 49% to 52% and 27%. Relative shifts in site of service to the hospital outpatient setting occurred for both procedures.

Conclusions

Since 1993, paracentesis procedures on Medicare beneficiaries have more than doubled, while thoracentesis volumes have declined slightly. Radiologists now far exceed gastroenterologists and pulmonary and critical care medicine physicians, respectively, as the predominant providers of these services. Those shifts are likely attributable to both the incremental safety of imaging guidance and also the unfavorable economics of these procedures.

Introduction

The result of a variety of different disease processes, ascites and pleural effusions are both associated with significant morbidity [1, 2, 3, 4]. For both diagnostic and therapeutic purposes, the first line of invasive therapy for both is aspiration by paracentesis and thoracentesis, respectively [1, 5, 6, 7]. Both services have historically been performed as bedside procedures, but the use of imaging guidance, often by radiologists, is increasingly advocated [5, 6, 8, 9, 10, 11, 12, 13].

Anecdotally, many radiology practices have experienced marked increases in the frequency of requests for these services, but to our knowledge, this observation has never been formally and widely validated. Using Medicare claims data, we report national trends herein.

Section snippets

Methods

Methodology similar to that used to evaluate trends in other minimally invasive procedures was used [14, 15, 16, 17, 18, 19]. Annual Medicare Physician Supplier Procedure Summary (PSPS) Master Files from 1993 through 2008 were acquired from the Center for Medicare and Medicaid Services (CMS) and used as the basis for our analysis. These files include summary data from all claims for all beneficiaries in Medicare's traditional fee-for-service program, which currently covers approximately 78% of

Results

Between 1993 and 2008, paracentesis services on Medicare fee-for-service beneficiaries increased from 64,371 to 149,699 (+85,328 [+133%]). Specialty group trends are detailed in Figure 1 and Table 1. Of note, radiologists' procedure volume increased by 964% over the 15-year period, well more than any other specialty group, making radiology now by far the predominant specialty provider of this service. Gastroenterologists, the largest specialty provider group in 1993, on the other hand,

Explaining the Changes

As many medical services are being provided with increasing frequency by changing and nontraditional specialties, the delivery of health care in the United States continues to evolve. Many minimally invasive procedures traditionally performed by radiologists, such as peripheral vascular interventions, have shifted to other specialists, most notably cardiologists and vascular surgeons [14, 15, 16]. Other minimally invasive procedures, such as breast interventions, however, have evolved so that

Conclusions

In summary, paracentesis services on Medicare beneficiaries have doubled over the past 15 years, as thoracentesis services have declined slightly. For both procedures, radiologists have become, by far, the predominant providers. That specialty shift is likely attributable to both the increased safety afforded by imaging guidance and also the unfavorable provider economics of these services.

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