Abstract
Introduction
Hemorrhoid disease is very common problem in the Medicare population. Prior work has
shown significant variation in county-level practices of hemorrhoidectomy; however,
regional variation of rubber band ligation (RBL) has yet to be assessed. This is important
as many different practitioners from different specialties can perform this procedure
repeatedly in an office-based setting. We aim to evaluate the variation of RBL and
hemorrhoidectomy over a 7-y period.
Methods
Using Medicare part B claims data, we identified all beneficiaries >65 y seen for
hemorrhoid disease between 2006 and 2013. Current Procedural Terminology (CPT) codes
were used to identify all events for hemorrhoidectomy (46083, 46250, 46255, 46257,
46260, and 46261) or RBL (46221) by hospital referral region (HRR). We determined
HRR-level rates of hemorrhoidectomy and RBL per 1000 beneficiaries adjusted for age,
sex, and race. We calculated annual coefficients of variation (SD × 100/mean) for
hemorrhoidectomy and RBL.
Results
1.2 to 1.3 million fee-for-service Medicare beneficiaries were seen annually for evaluation
of hemorrhoid disease. Mean-adjusted annual rates for hemorrhoidectomy by HRRs varied
from 4.34 to 63.03 per 1000 beneficiaries. Mean-adjusted rates of RBL by HRRs varied
from 7.06 to 163 per 1000 beneficiaries. Annual procedural coefficients of variation
over the study period were 41-48 (high) for hemorrhoidectomy and 69-74 (very high)
for RBL.
Conclusions
While continued high variation exists for hemorrhoidectomy, there is very high variation
for RBL between HRRs in treating hemorrhoid disease among Medicare beneficiaries.
There are substantial Medicare expenditures in this high-volume population that are
likely unwarranted.
Keywords
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Article info
Publication history
Published online: November 26, 2022
Accepted:
October 8,
2022
Received in revised form:
August 7,
2022
Received:
May 11,
2022
Identification
Copyright
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