TAVR operator volumes, trends, and geographic variations amongst Medicare beneficiaries in the United States

Abstract

Objectives: To evaluate transcatheter aortic valve replacement (TAVR) operator procedural volumes, and describe temporal and geographic trends.Background: TAVR is the standard of care for most patients with severe symptomatic aortic stenosis. Despite an association between operator procedural volume and outcomes, nationwide TAVR operator volumes have been incompletely described.Methods: We queried the National Medicare Provider Utilization and Payment Database for transfemoral TAVRs from 2014 to 2018. Annual operator volume, state and regional volumes, and longitudinal trends were extracted and analyzed using descriptive statistics.Results: In 2018, the mean annual operator volume was 23.6 TAVRs. The highest 1% of operators by volume performed 7.6% of total TAVR procedures in the United States, while 35.7% of operators performed 10 or fewer TAVRs per year. From 2014 to 2018, there was a 53.9% annualized increase in TAVRs, and the mean annual volume per operator grew from 12.5 to 23.6. There was more than five-fold variability in the density of operators (range 0.35-1.79 operators per 100,000 population) and mean operator volume by state (range 14.2-52.4 TAVRs per operator). Conclusions:In this nationally representative study of operators performing transfemoral TAVRs among Medicare patients, we found the mean annual volume of TAVR in 2018 to be 23.6 and has increased since 2014. There was considerable variability in operator density and procedural volumes, with a significant proportion of operators performing 10 or fewer TAVRs per year. Ambiguity remains in regard to the optimal balance of procedural requirements to sustain high efficacy outcomes and ensure critical access to TAVR therapies.

Reaching the optimal volume‐quality balance in transfemoral transcatheter aortic valve replacement

“…3 It is in this context that the current report 4 for TF-TAVRs from 2014 to 2018. 4 They examined operators' TF-TAVR volumes per year, temporal trends in volumes, and geographic variation in operators' density and procedural volumes. They showed that from 2014 to 2018, there was a 54% annualized increase in TAVR volume and a 31% annual increase in the number of operators, with the mean annual operator volume of TAVR increasing to 24 procedures (from mean 12.5 in 2014).…”

“…It is in this context that the current report 4 should be viewed. The investigators evaluated data from the National Medicare Provider Utilization and Payment Database (MPUPD) for TF‐TAVRs from 2014 to 2018 4 .…”

“…It is in this context that the current report 4 should be viewed. The investigators evaluated data from the National Medicare Provider Utilization and Payment Database (MPUPD) for TF‐TAVRs from 2014 to 2018 4 . They examined operators' TF‐TAVR volumes per year, temporal trends in volumes, and geographic variation in operators' density and procedural volumes.…”

“…1 It is important to highlight some of the limitations of the current study. 4 The authors calculated the mean operator TAVR volume by dividing the number of procedures by the total number of operators (including interventional cardiologists and cardiac surgeons). TAVR procedures are performed by a team of at least one interventional cardiologist and one cardiac surgeon working jointly, each submitting a separate claim for payment.…”

“…It is important to highlight some of the limitations of the current study 4 . The authors calculated the mean operator TAVR volume by dividing the number of procedures by the total number of operators (including interventional cardiologists and cardiac surgeons).…”