The past two decades have seen a drastic decline in enteral access procedures among Medicare patients, according to a study published in the Journal of Vascular and Interventional Radiology.

The Harvey L. Neiman Health Policy Institute used Medicare claims data from 1994 to 2012 to identify trends in the use of enteral access, including the use of devices such as feeding tubes to deliver nutrients or medication directly to the gastrointestinal tract.

Lead author and University of Pennsylvania radiology resident Wenshuai Wan, MD, testified to a 31 percent decrease during the 18 years captured by the study, with radiologists surpassing gastroenterologists as the primary provider of enteral access procedures. In addition, enteral access maintenance procedures have increased by about 25 percent.

“The transition of enteral access maintenance services from the hospital to the emergency room setting demonstrates a shift in the provider base while also indicating the urgency or perceived urgency for enteral feeding access maintenance by patients and their caretakers,” noted Richard Duszak, MD, FACR, professor and vice chair for health policy and practice in the department of radiology and imaging sciences at Emory University and affiliate senior research fellow at the Harvey L. Neiman Health Policy Institute.

Interventional radiologists are playing a much larger role in maintaining access sites, according to Duszak.

“These findings should help radiologists and their health system provider partners develop integrated practice units and alternative payment models for cost-effective care of conditions requiring enteral access,” added Wan.