Original articleNational Fluid Shifts: Fifteen-Year Trends in Paracentesis and Thoracentesis 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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