Radiologists grab growing share of enteric tube-placement market, Medicare data reveal

Radiologists are grabbing a growing share of the enteric tube-placement market according to new data published in Clinical Imaging.

There are various reasons for this method of placing a feeding tube, including swallowing disorders, esophageal obstructions, or malignancies of the head and neck. However, it can also lead to complications during end-of-life care or for patients with advanced dementia, noted experts with the University of Pittsburgh.

Given these concerns, placement of all enteric tubes decreased 32% among Medicare recipients between 2010-2018. While endoscopic placement fell 39% during that period as gastroenterologists lost ground, insertion using fluoroscopy climbed 18%, up to more than 21,000 procedures by the end of the study period.

“Radiologists, presumably mostly IRs, performed a large majority of these image-guided procedures,” corresponding author and Pitt radiologist Rajoo Dhangana, MD, and colleagues wrote May 18. “The increasing role of IR may be multifactorial and related to certain patient factors, reimbursement trends and practice patterns. Additionally, with an aging population along with a greater number of patients with comorbidities and altered gastric anatomy, percutaneous gastrostomy placement with little or no sedation may be preferable.”

To reach their conclusions, Dhangana et al. analyzed Medicare claims, pinpointing CPT codes for varying methods of tube placement. They found that interventional radiologists delivered the lion’s share of fluoroscopy-based procedures in 2018 at nearly 92% (up from 82%). Meanwhile, surgical placement fell by 25% during the study period, while the volume of imaging-guided instances increased 55% up to more than 38,000. Alongside radiologists, advanced practice providers also saw their market share climb—more than doubling during the study period. Despite an increase in imaging-guided replacements, the emergency department remained the most common location of delivery (34% in 2018) followed by on-campus, outpatient hospitals (31%).

Pitt researchers hypothesized several reasons for the shift toward imaging. Physician reimbursement for new placement of enteric tubes declined during the study period. But fluoroscopic-guided, per-procedure payment fell only 11% compared to a nearly 19% drop for endoscopically placed tubes. This correlated with RVU values of 3.93 for fluoroscopy versus 3.56 for endoscopic placement of gastronomy tubes. The American Geriatrics Society also released a position statement in 2014, recommending against the use of feeding tubes for older adults with advanced dementia.

“Regarding practice patterns, IR's participation in the management of existing enteric tubes has significantly increased from 2010 to 2018,” the authors added. “While the emergency department still plays an important role in replacement of dislodged and malfunctioning enteric tubes, replacements are being increasingly performed in the fluoroscopy suite, in many cases presumably on an elective rather than urgent basis. Therefore, by becoming a more dominant player in enteric tube management, IR practices may drive increased volume of de novo placement.”

You can read more about their findings in the New York Roentgen Society’s official journal here.

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