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Contribution Margins For Lower-extremity Endovascular Interventions Among Medicare Beneficiaries
Esteban Calle, MD, Kathryn DiLosa, Amit Chawla, Yash Singh, Denise Danos, Claudie Sheahan, Malachi Sheahan.
Louisiana State University, New Orleans, LA, USA.
ABSTRACTOBJECTIVE: Comprehensive data concerning contribution margins (CMs) generated by peripheral vascular interventions (PVI) in US hospitals are lacking. We aimed to evaluate the costs, revenue, and CMs for PVI frequently performed by vascular surgeons.
METHODS: A retrospective cohort of all infrainguinal PVI for treatment of femoral, popliteal and tibial lesions performed on
fully covered Medicare beneficiaries ≥65 years in the inpatient setting between 2017-2021 was retrieved from the Centers for Medicare and Medicaid Services (CMS) databases. Procedures were identified using ICD-10 codes and CMs calculated as the difference between total revenue and total costs. Elective and non-elective interventions for all indications were included in the cohort for analysis
.RESULTS: Data from a cohort of 151,772 claims for both elective and non-elective PVIs revealed that CMs remain negative for the study period for all included procedures. From year to year during the study period there were stable findings across procedure types reflecting consistent financial costs for these interventions. For included procedures, the median revenue ranged from $22,641 to $27,315 and costs $24,692 to $30,082, with a negative CM of $-1,778 to $-6,832.
Table 1 The median losses remained stable over time, with little year-to-year variation during the study period. Higher-cost procedures such as transluminal stent placement for both femoral/popliteal and tibial regions showed the most pronounced negative margins, and distal interventions generally created lower contribution margins in total. The overall trend indicates a decline in inpatient Medicare procedure volumes after 2019, consistent across all lower-extremity endovascular procedures.
CONCLUSIONS: Consistent with prior literature demonstrating rising procedure costs outstripping reimbursement, we observed generally negative contribution margins for all PVIs performed in the inpatient setting, likely the result of increased patient acuity and higher facility costs. Similarly, more distal tibial interventions offered the lowest CM among
infrainguinal interventions, undervaluing the effort associated with such interventions and the complexity of the disease process in patients presenting with these lesions. Additional work is needed to provide a comprehensive understanding of the scope of practice and the value offered by vascular surgeons both in the inpatient and outpatient setting.
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