Abstract No. 294 Analysis of Non-Tunneled Central Venous Catheter Placement Trends Among Medicare Patients (2010-2022): Procedural Volume, Specialty Involvement, and Reimbursement Patterns

Non-tunneled central venous catheter placement is a commonly performed procedure for various indications, including repeated blood sampling, administration of vasoactive medications, rapid fluid resuscitation, prolonged antibiotic therapy and occasionally chemotherapy. Historically, these procedures have been performed at bedside by non-radiology provider. Limited data exists on volume trends and specialist involvement among Medicare patients. We conducted this research using data sourced from publicly available databases provided by the Center for Medicare and Medicaid Services (CMS). Our dataset comprised billing data from the CMS Physicians/Supplier Procedure Summary (PSPS) Master Files spanning from 2010 to 2022. The billing code 36556 was used for this analysis. The volume of non-tunneled central venous catheter placements has ranged from 23, 957 in 2010 to 16, 470 in 2022. General surgery accounted for the largest share at 19. 4% in 2010, followed by internal medicine (12. 5%) and vascular surgery (11. 3%). However, in 2022, general surgery's involvement had decreased to 12. 8% of total non-tunneled central venous catheter placements, whereas radiology and interventional radiology had increased their participation to 11. 7% and 7. 3%, respectively. A substantial drop in number of catheter placements by internal medicine and nephrology was noted, from 12. 5% to 6. 9% and 4% to 1. 8% respectively. This could be linked to more referrals from hospitalists and nephrology providers to interventional radiology (IR) for non-tunneled central venous catheter placement. The majority of these procedures (84. 2%) were performed on an inpatient basis. Analyzing the average submitted charges for central venous catheter placement in 2022, we found that general surgery had higher charges at 847 compared to radiology and interventional radiology, which reported charges of 670. 2 and 685. 4, respectively. Our study highlights a growing trend among Medicare patients, where radiologists are increasingly performing non-tunneled central venous catheter placements at a lower cost compared to general surgery. Placement of non-tunneled central venous access by internal medicine and nephrology providers have decreased significantly with more of these providers referring to IR. This is anticipated to increase in the future, with ABIM dropping minimum procedural requirements for ABIM graduates.