Original article
Health services research and policy
Rising Retrieval Rates of Inferior Vena Cava Filters in the United States: Insights From the 2012 to 2016 Summary Medicare Claims Data

https://doi.org/10.1016/j.jacr.2018.01.037Get rights and content

Abstract

Background

To determine recent inferior vena cava filter (IVCF) retrieval volumes and rates in the Medicare population.

Methods

The summary Medicare claims data were searched for the years 2012 to 2016 to identify the frequency of IVCF placements and retrievals. The new Healthcare Common Procedure Coding System code for filter retrieval introduced in 2012, 37193, was used to track filter retrievals. Trends in number of IVCF placements and retrievals over the study period were evaluated, both of which were further stratified by physician specialty and site of service. Aggregate and compound annual growth rates for retrievals were also computed.

Results

A total of 255,034 filters were placed over the study period, with the filter placement volume declining from 61,889 in 2012 to 38,095 in 2016. Filter retrievals, however, increased from 4,327 in 2012 to 8,405 in 2016. The net filter retrieval rate per annual filters placed increased from 6.9% in 2012 to 22.1% in 2016, yielding an average filter retrieval rate and compound annual growth rate of 11.6% and 18.1% respectively. Radiologists placed and retrieved the majority of filters (60.4% placed, 63.5% retrieved) compared with nonradiologists. The inpatient setting was the dominant site for filter placement compared with the outpatient setting for filter retrieval across all years and specialties.

Conclusions

Since introduction of the unique Healthcare Common Procedure Coding System code for IVCF retrieval in 2012, IVCF placements in the Medicare population have been declining and net retrieval rates have risen. Radiologists continue to place and retrieve the majority of filters.

Introduction

Inferior vena cava (IVC) filters have been increasingly used in the United States despite the paucity of evidence to determine their efficacy [1]. Although earlier studies had shown increasing filter utilization over the past 3 decades [2], recent studies have demonstrated a statistically significant decline in filter placements after the 2010 FDA safety communication regarding the potential long-term complications of filter implantation 3, 4. Duszak et al estimated that the filter retrieval rate in the Medicare population ranged from 1.2% to 5.1%; however, this study was based on a nonspecific Current Procedural Terminology code for foreign body removal to identify filter retrievals [5]. Subsequent to this study, new IVC filter placement and retrieval codes were introduced in 2012; however, no studies have yet investigated filter retrieval using these specific codes in the Medicare population, particularly in the wake of the 2010 FDA warning and subsequent declining filter utilization [6]. The purpose of this study was to determine the volume of IVC filter placements and retrievals in the Medicare population from 2012 to 2016 and also calculate the aggregate retrieval rates over this study period.

Section snippets

Data Source

The Annual Medicare Physician Supplier Procedure Summary (PSPS) master files from 2012 to 2016 were obtained from the CMS. These files aggregate the Part B Medicare billing claims submitted by physicians and other health care providers in the United States and represent the largest amount of aggregate health service frequency data in the country. The data include codes for procedure, region, place of service, and provider specialty. The number of procedures and the allowed charges are included.

Results

IVC filter placements declined from 61,889 in 2012 to 38,095 in 2016, with a total 255,034 filters placed over the study period (Fig. 1). The aggregate linear yearly decline rate in filter placements was −9.6% per year. Filter retrievals, however, increased from 4,327 in 2012 to 8,405 in 2016, with a total of 29,508 retrievals performed over the study period. The CAGR for annual filter retrievals during the period studied was 18.1%. When analyzed by specialty, the CAGR was 19.3% for

Discussion

The present study further confirms a national decline in IVC filter placements while also concurrently demonstrating an increase in IVC filter retrieval trends from 2012 to 2016, despite medical literature indicating relatively unchanged diagnoses of venous thromboembolism [7]. The net effect from these findings is an increased percentage of IVC filters retrieved among the Medicare population in the United States.

The utilization of IVC filters had been increasing over the past few decades [2],

Take-Home Points

  • IVC filter placements trends have decreased from 2012 to 2016 in the Medicare population, and filter retrievals have increased, resulting in a steadily increasing filter retrieval rate.

  • Radiologists represent the dominant providers compared with nonradiologists in IVC filter placement and retrieval procedures.

Cited by (59)

View all citing articles on Scopus

Osman Ahmed, MD, is an Advisory Board Member for Bayer and a speaker for Spectranetics. Bulent Arslan, MD, is a consultant for Cook, Penumbra, Medtronic, and Guerbet. The other authors have no conflicts of interest related to the material discussed in this article.

View full text