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Variety of specialists performing carotid stenting
Nallamothu BK. Arch Intern Med. 2011;doi:10.001/archinternmed.2011.354
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Most carotid stenting procedures are performed by cardiologists, but the remainder are performed by operators across other specialties, according to a study published in the Archives of Internal Medicine.
Researchers from the University of Michigan Medical School obtained Physician Carrier, Medicare Provider Analysis and Review and Denominator files from 2005 to 2007 from CMS. They determined the specialty of the operator performing the procedure and categorized them into three groups: those performed by cardiologists, those performed by surgeons and those performed by radiologists.
The researchers also assigned each procedure to one of 306 hospital referral regions, which were categorized into three groups: those where cardiologists performed most of the stenting procedures, those where surgeons performed the most and those where radiologists performed the most.
A total of 28,700 procedures were performed during the study period: 52% were performed by cardiologists; 27.3% by surgeons; 17.8% by radiologists; and 3.2% by other specialists. Among the operators, 34.9% were cardiologists; 33.4% were surgeons; 27.8% were radiologists; and 3.9% were other specialists.
Across each hospital referral region, the proportion of stenting performed by cardiologists varied, ranging from 0% in two regions to 100% in one region. In 115 of the regions, cardiologists performed the most, whereas in 41 of the regions, surgeons performed the most, and in 37 of the regions, radiologists performed the most. In regions where cardiologists performed most procedures, there were higher population-based utilization rates.
 Gary M. Ansel |
This study took place at a time where most of carotid stenting was done on research protocols. The approval and reimbursement for carotid stenting has been limited so that we have approval for about 15% of the patient population. When you start looking at physician specialties for carotid stenting, especially for Medicare patients, it’s hard to draw any conclusions because it’s not apples to apples. When it talks about cardiologists having a higher population-based utilization rate, it is very hard to generalize that to general practice once the device is approved. There is very little of a conclusion as far as how this will affect the Medicare population.
– Gary M. Ansel, MD
Cardiology Today
Intervention Editorial Board member
Disclosure: Dr. Ansel
was the co-national principal investigator for the CREATE and MoMMa
protocols.