Chronic Venous Insufficiency Skyrockets Among Medicare Patients

Medicare beneficiaries with chronic venous insufficiency nearly triples from 2005 to 2014.

The incidences of chronic venous insufficiency (CVI) among Medicare beneficiaries increased significantly from 2005 to 2014, according to a study published by the Journal of Vascular and Interventional Radiology.

CVI is a condition in which the valves in the veins in do not work properly, mainly affecting the legs. This condition causes blood to pool in the affected areas and increases blood pressure. Physicians may recommend non-invasive treatments, such as exercise, use of compression stockings, and weight loss. Additional treatments include vein ablation and angioplasty, according to the Society for Vascular Surgery.

The authors of the study aimed to determine the burden of CVI among elderly Americans.

Included in the study were claims data from the Centers for Medicaid and Medicare Services for CVI treatment trends. The authors focused on newer, minimally invasive procedures, and those performed on site and by specialists, according to the study.

"We discovered that between 2005 and 2014, total services for CVI in the Medicare fee-for-service population grew from 95,206 to 332,244," said lead study author Anand M. Prabhakar, MD, MBA.

The authors found that the growth in procedures was driven by minimally invasive surgeries, such as radiofrequency ablation and laser ablation. The use of radiofrequency ablation increased from 0.3 per 1000 beneficiaries in 2005 to 2.6 per 1000 beneficiaries in 2013, according to the study.

During this time, a majority of procedures performed in an office setting, with the rate increasing from 87% in 2005 to 92% in 2014.

Additionally, services provided to Medicare beneficiaries with CVI were largely performed by surgeons. The authors found that vascular surgeons and other surgeons accounted for 33% and 29%, respectively, of the market share in 2005. This decreased to 26% for vascular surgeons and 25% other surgeons in 2014, but the authors noted this group of healthcare professionals still performed the most CVI procedures, according to the study.

Interestingly, the authors noted that while vascular and other surgeons dominated the market share, radiologists and cardiologists had more rapid growth. Radiologists performing CVI procedures increased 23% and cardiologists increased 51% from 2005 to 2014.

"As a group, cardiology experienced the most rapid growth in market share from 2005 to 2014 for all CVI procedures, far outpacing that of radiology, vascular surgery, other surgery, and primary care providers," Dr Prabhakar said. "For interventional radiology to play a more prominent role, it is critical that trainees learn how to run a consultative practice, including how to evaluate and manage patients with CVI."

These findings can be used to help Medicare officials better understand the measures needed to determine quality among patients with CVI receiving care from various providers, according to the study. Additionally, the data can be used to determine which type of specialist and procedures should be covered due to optimal outcomes.

"Our results show that a number of different specialists are currently performing a wide mix of procedures for this clinical condition," said researcher Richard Duszak, MD, FACR. "The findings now serve as a foundation for future work to systematically compare quality and patient outcomes associated with the various procedures and performing specialists to help shape policy and practice patterns to optimize patient care."