Do interventional radiologists pose a significant threat to the practice of vascular surgery?

PURPOSE: Vascular surgeons have become concerned recently about perceived t hreats to their practices posed by the growth of interventional radiology. The authors studied nationwide 1996 Medicare Part B procedure data to deter mine the seriousness of these threats. MATERIALS AND METHODS: The national Health Care Financing Administration (H CFA) Physician/Supplier Procedure Summary Master File for 1996 was searched . Two hundred thirteen distinct Current Procedural Terminology (CPT-4) code s were identified for therapeutic surgical and percutaneous interventional procedures performed to treat noncardiac vascular diseases. For each code, determination was made of total volume, specialty of the physician provider s, and Medicare Part B reimbursement dollars paid to the providers as profe ssional fees. In view of the conflicts among various specialties over perip heral vascular interventions, the authors also determined the percentages o f these procedures performed by radiologists, surgeons, cardiologists, and other physicians. RESULTS: A total of 759,548 noncardiac therapeutic vascular procedures (ope rations or percutaneous interventions) were performed during 1996 in patien ts receiving Medicare benefits. Radiologists performed 135,103 (17.8%) of t hese procedures but received only 10.4% of professional reimbursements. By contrast, surgeons performed 510,871 (67.3%) procedures, but received 78.0% of professional reimbursements. Cardiologists performed 4.7% of procedures and other specialists performed the remaining 10.3%. Radiologists performe d 75.5% of percutaneous transluminal angioplasties, the majority of thrombo lysis procedures, stent placements, and portal decompression procedures, an d approximately half of inferior vena cava interruptions. Cardiologists per formed 12.6% of percutaneous transluminal angioplasties, surgeons performed 6.3%, and other specialists performed 5.6%. CONCLUSIONS: In terms of overall physician workload and professional reimbu rsements paid for invasive treatment of all types of noncardiac vascular di sease, surgeons predominate and do not appear to be seriously threatened by interventional radiologists. Radiologists perform three-fourths of noncard iac percutaneous transluminal angioplasties and a majority of other percuta neous interventional therapies for vascular disease, but some inroads have been made by cardiologists and surgeons, particularly the former.