Venous Ablation Procedures by Provider Type, Including Advanced Practice Providers.

OBJECTIVE: The necessary training and certification of providers performing venous ablation has become a topic of debate in recent years. As venous interventions have shifted away from the hospital, the diversity of provider backgrounds has increased. We aimed to characterize superficial venous ablation practice patterns associated with different provider types.

METHODS: We analyzed Medicare fee-for-service data from 2010 through 2018. Procedures were identified by their Current Procedural Terminology (CPT) code and included radiofrequency ablation, endovenous laser ablation, chemical adhesive ablation (i.e., VenaSeal®), and mechanochemical ablation. These procedures were correlated with the practitioner type to identify provider-specific trends.

RESULTS: Between 2010 and 2018, the number of ablation procedures rose by 107% from 114,197 to 236,558 per year (p<0.001). Most procedures were performed by surgeons without vascular board certification (28.7%, 95% CI [28.7, 28.8]), followed by vascular surgeons (27.1%, 95% CI [27.0, 27.2]). Traditionally non-interventional specialties, which exclude surgeons, cardiologists, and interventional radiologists, accounted for 14.1% (95% CI [14.1, 14.2]), and APPs accounted for 3.5% (95% CI [3.4, 3.5]) of all ablation procedures during the time frame. The total number of ablations increased by 9.7% annually (95% CI [9.7, 9.8]), whereas procedures performed by APPs grew by 62.0% annually (95% CI [61.6, 62.4]). There were significant differences between specialties in the use of non-thermal ablation modalities: APPs had the highest affinity for non-thermal ablation (OR 2.60, 95% CI [2.51, 2.69]). Cardiologists were also more likely to use non-thermal ablation (OR 1.62, 95% CI [1.59, 1.66]). Similarly, the uptake of new non-thermal technology (i.e., chemical adhesives) was greatest among APPs (OR 3.57, 95% CI [3.43, 3.70]) and cardiologists (OR 1.86, 95%,CI [1.81, 1.91]). Vascular surgeons were less likely to use non-thermal modalities (OR 0.95, 95% CI [0.92, 0.97]), including new non-thermal technology in the first year of availability (OR 0.93, 95% CI [0.90, 0.95]).

CONCLUSIONS: Venous procedures have grown rapidly over the past decade, particularly as endovenous ablations have been performed by a wider practitioner base including APPs and non-interventionalists. Practice patterns differ by provider type, with APPs and cardiologists skewing more toward non-thermal modalities, including more rapid uptake of new non-thermal technology. Provider-specific biases for specific ablation modalities may reflect differences in training, skill set, the need for capital equipment, clinical privileges, or reimbursement. These data may help to inform training paradigms, allocation of resources, and evaluation of appropriateness in a real-world setting.