Some physicians may be overusing an invasive vascular procedure for patients with mild disease — making millions in the process, a ProPublica investigation into CMS data found.
ProPublica worked with health analytics group CareSet to analyze CMS data of atherectomy procedures and found many outpatient vascular centers performed the procedure on older patients for multimillion-dollar Medicare payouts.
Atherectomies, a procedure that uses a laser or bladed catheter to remove plaque from the patient's vessel walls, is appropriate for severe vascular disease experts said, but according to data, the majority of patients receiving the procedure have milder conditions like claudication.
ProPublica found that nearly 1 in 4 patients who underwent a first-time atherectomy between 2019 and 2022 were only diagnosed with claudication. "This amounts to nearly 30,000 patients who may have undergone procedures too soon or possibly even unnecessarily," the report said.
About 170 physicians performed half or more of their first-time atherectomies on patients with mild conditions. Combined, the small group of mostly vascular surgeons, interventional radiologists and cardiologists earned nearly $1.5 billion in five years and conducted almost 200,000 procedures, according to the report. One Beverly Hills radiologist received more than $45 million from Medicare over five years and performed over 7,000 atherectomies.
"It's concerning that we may be doing unnecessary procedures and spending unnecessary health care dollars." Caitlin Hicks, MD, an associate professor of surgery at Johns Hopkins University School of Medicine and a leading researcher on procedure overuse, said in the report. "We know that aggressive interventions for claudication may give short-term relief, but in the long term, patients are the same as they started or even worse."
Advocates have called on CMS to address the issue over the last several years, but the agency has not done anything yet, according to the report. A CMS spokesperson told ProPublica that the agency monitors claims data for outliers and can deny claims, suspend payment or notify law enforcement if it identifies issues.