Clinical Study
Disparities over Time in Volume, Day of the Week, and Patient Complexity between Paracentesis and Thoracentesis Procedures Performed by Radiologists versus Those Performed by Nonradiologists

https://doi.org/10.1016/j.jvir.2019.04.015Get rights and content

Abstract

Purpose

To compare the disparities between the paracenteses and thoracenteses performed by radiologists with those performed by nonradiologists over time. Variables included the volume of procedures, the days of the week, and the complexity of the patient’s condition.

Materials and Methods

Using carrier claims files for a 5% national sample of Medicare beneficiaries from 2004 to 2016, paracentesis and thoracentesis examinations were retrospectively classified by physician specialty (radiologist vs nonradiologist), day of the week (weekday vs weekend), and the complexity of the patient’s condition (using Charlson comorbidity index scores). The Pearson chi-square and independent samples t-test were used for statistical analysis.

Results

Between 2004 and 2016, the proportion of all paracentesis and thoracentesis procedures performed by radiologists increased from 70% to 80% and from 47% to 66%, respectively. Although radiologists increasingly performed more of both services on both weekends and weekdays, the share performed by radiologists was lower on weekends. For most of the first 9 years across the study period, radiologists performed paracentesis in patients with more complex conditions than those treated by nonradiologists, but the complexity of patients’ conditions was similar during recent years. For thoracentesis, the complexity of patients’ conditions was similar for both specialty groups across the study period.

Conclusions

The proportion of paracentesis and thoracentesis procedures performed in Medicare beneficiaries by radiologists continues to increase, with radiologists increasingly performing most of both services on weekends. Nonetheless, radiologists perform disproportionately more on weekdays than on weekends. Presently, radiologists and nonradiologists perform paracentesis and thoracentesis procedures in patients with similarly complex conditions. These interspecialty differences in timing and complexity of the patient’s condition differ from those recently described for several diagnostic imaging services, reflecting the unique clinical and referral patterns for invasive versus diagnostic imaging services.

Section snippets

Methods

The retrospective use of Medicare administrative claims data for this study was performed in a manner compliant with Health Insurance Portability and Accountability Act of 1996 (HIPAA), with the approval of the Institutional Review Board of the American College of Radiology.

The methodology used for data collection and analysis was similar to that used previously 7, 8, 9. Under a data use agreement from the Centers for Medicare and Medicaid Services, patient-level 5% Medicare Part B Research

Volume of Paracentesis Procedures Performed by Specialty and Day of the Week

Of 83,217 paracentesis procedures performed between 2004 and 2016 in the 5% Medicare beneficiary cohort, a provider specialty could not be determined for 46 procedures (0.06%). For the remaining procedures, annual performance of paracentesis, normalized per 100,000 Medicare beneficiaries, increased from 3,684 to 5,378 (46% growth; CAGR, 3.2%). Annual use of paracentesis by radiologists increased from 2,584 to 4,311 (67% growth, CAGR 4.4%), and annual use of paracentesis by nonradiologists

Discussion

Medicare patient-level claims data from 2004 to 2016 were used to analyze longitudinal interspecialty differences between radiologists and nonradiologists in the performance of paracentesis and thoracentesis procedures with respect to overall volume, day of the week, and the complexity of the patient’s condition. Estimating these procedures to be performed a total of 163,000 and 215,000 times, respectively, in Medicare beneficiaries nationwide, both are common procedures. For both paracentesis

Acknowledgments

This work was funded in part by the Harvey L. Neiman Health Policy Institute (Reston, Virginia).

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    D.R.H. and R.D. receive research support from the Harvey L. Neiman Health Policy Institute (Reston, Virginia). None of the other authors have identified a conflict of interest.

    Table E1 can be found by accessing the online version of this article on www.jvir.org and clicking on the Supplemental Material tab.

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