Conflict of interest: One of the authors, Mr. Wayne Powell, is a staff member of the Society for Cardiovascular Angiography and Interventions in the Department of Advocacy and Guidelines. The authors have no other conflicts of interest or industry relationships to disclose.
Coronary Artery Disease
Current operator volumes of invasive coronary procedures in medicare patients: Implications for future manpower needs in the catheterization laboratory†
Article first published online: 2 MAY 2012
Copyright © 2012 Wiley Periodicals, Inc.
Catheterization and Cardiovascular Interventions
Volume 81, Issue 1, pages 34–39, 1 January 2013
How to Cite
Maroney, J., Khan, S., Powell, W. and Klein, L. W. (2013), Current operator volumes of invasive coronary procedures in medicare patients: Implications for future manpower needs in the catheterization laboratory. Cathet. Cardiovasc. Intervent., 81: 34–39. doi: 10.1002/ccd.24366
- Issue published online: 21 DEC 2012
- Article first published online: 2 MAY 2012
- Accepted manuscript online: 16 MAR 2012 10:47AM EST
- Manuscript Accepted: 13 FEB 2012
- Manuscript Received: 21 OCT 2011
- diagnostic cardiac catheterization;
- percutaneous coronary intervention;
- angiography—coronary angiography
We seek to assess the per-operator volume of diagnostic catheterizations and percutaneous coronary interventions (PCI) among US cardiologists, and its implication for future manpower needs in the catheterization laboratory.
The number of annual Medicare PCIs peaked in 2004 and has trended downward since, however the total number of catheterization laboratories nationwide has increased. It is unknown whether these trends have resulted in a dilution of per-operator volumes, and whether the current supply of interventional cardiologists is appropriate to meet future needs.
We analyzed the Centers for Medicare and Medicaid Services 2008 Medicare 5% sample file, and extracted the total number of Medicare fee-for-service (Medicare FFS) diagnostic catheterizations and PCIs performed in 2008. We then determined per-physician procedure volumes using National Provider Identifier numbers.
There were 1,198,610 Medicare FFS diagnostic catheterizations performed by 11,029 diagnostic cardiologists, and there were 378,372 Medicare FFS PCIs performed by 6,443 interventional cardiologists in 2008. The data reveal a marked difference in the 2008 distribution of diagnostic catheterizations and PCIs among operators. Just over 10% of diagnostic catheterizations were performed by operators performing 40 or fewer Medicare FFS diagnostic catheterizations, contrasted with almost 30% of PCIs performed by operators with 40 of fewer Medicare FFS PCIs. A significant majority of interventional cardiologists (61%) performed 40 or fewer Medicare FFS PCIs in 2008.
There is a high percentage of low-volume operators performing PCI, raising questions regarding annual volume recommendations for procedural skill maintenance, and the future manpower requirements in the catheterization laboratory. © 2012 Wiley Periodicals, Inc.