(PC234) Economic and Quality Impact Associated with the Overutilization of Vascular Ultrasound to Diagnose Vascular Access Thrombosis

Objectives: The prevalence of end-stage kidney disease (ESKD) is increasing, and the patient population accounts for 7% of Medicare spending. Value-Based Care (VBC) models have been implemented to control expenditures and maintain care quality. The patent, functional vascular access circuit (VAC) is essential to deliver prescribed renal replacement therapy. In experienced hands, physical examination provides 100% sensitivity for vascular access thromboses (VAT). Notwithstanding, vascular ultrasound (vUS) is routinely used to make and confirm the diagnoses. This quality study examines the use pattern, direct economic and indirect opportunity costs

Methods: This single-center, retrospective study includes all patients who underwent vUS to diagnose VAT between January 2014 and December 2024. A chart review was performed to determine the access circuit type, study setting, ordering provider specialty, and the subsequent rendered treatment. The average time to perform vUS was one hour. We used the average reported cost of vUS ($2,520) and the national median hourly wage of a vUS technician ($42.15) to estimate the economic cost.

Results: A total of 690 patients met the criteria, 52.2% with arteriovenous fistula (AVF) and the remainder with arteriovenous graft thrombosis. The annual number of vUS exhibited an increase starting in 2019 (Figure 1). The vUS was most frequently ordered in outpatient settings (72.1%) and primarily by a vascular surgery provider (71.9%) (Table 1). Following vUS, 71.5% of patients underwent interventions. Of these, 40.4% received percutaneous thrombectomy (PCT) to salvage the VAC and 54.1% received new VAC creation. PCT was more common in AVG patients than AVF (54.4% vs. 26.1%). Healthcare payor billing impact $1.74 M; inpatient technician salaries $7,924; hospital alternative study opportunity cost: 690 hrs. .

Conclusions: The overutilization of vUS is associated with significant hospital and healthcare payor economic impact and rarely influences clinical management. The hospital's economic and opportunity costs are most substantial for inpatient studies. Our study highlights the need to reassess routine vUS utilization for VAT. Successfully doing so will improve VBC at the healthcare system and national payor level.