(PC076) Supervised Exercise Therapy is Almost Never Used Prior to Endovascular Peripheral Vascular Interventions for Claudication

Objectives: Supervised exercise therapy (SET) is an evidence-based first-line treatment for claudication that is supported by multiple professional guidelines. As of May 2017, the Centers for Medicare and Medicaid Services implemented a new policy to provide reimbursement for SET for beneficiaries with symptomatic peripheral artery disease. We aimed to evaluate the prevalence and trends of SET use within 12 months prior to index peripheral vascular intervention (PVI) for claudication among patients covered by public and private insurance payers.

Methods: We conducted a retrospective cohort study of patients undergoing index (first-time) PVI for claudication using claims data from Medicare (2017–2023), Medicare Advantage (2017–2019), Medicaid (2017–2021), and MarketScan (private payer; 2017–2021). Patients with chronic limb-threatening ischemia (CLTI), acute limb ischemia (ALI), or prior PVI were excluded. Use of SET or any type of physical therapy within 12 months prior to PVI were identified using CPT codes. Prevalence of and trends in SET and physical therapy use were analyzed across payer groups overall and by year using chi-squared tests and generalized linear models.

Results: We identified 231,559 patients undergoing PVI for claudication, including 158,431 with Medicare (mean age 74.158.24 years, 58.9% male, 82.1% white), 5,254 with Medicare Advantage (mean age 74.027.72 years, 57.9% male, 79.4% white), 60,428 with Medicaid (mean age 65.8511.15 years, 51.0% male, 44.5% white), and 7,446 with private insurance (mean age 57.885.53 years, 34.9% male). The prevalence of SET and physical therapy use within 12 month prior to PVI for claudication across all payers was 0.5% and 12.0%, respectively. Use of SET was highest among patients with private insurance (3.1%), followed by Medicaid insurance (1.2%), Medicare (0.12%), and Medicaid Advantage (0.02%) (P < 0.001; Figure). Similarly, the use of any physical therapy was highest among patients with private insurance (15.4%), followed by Medicaid insurance (13.3%), Medicare (11.4%), and Medicaid Advantage (1.2%) (P < 0.001). There was no significant change in use of SET over time across any payer groups (P>0.19 for all), but use of physical therapy increased for patients with Medicare (2017: 10.3% vs. 2023: 13.5%; P < 0.001) and Medicaid insurance (2017: 11.8% vs. 2021: 13.8%; P < 0.001).

Conclusions: Despite guideline recommendations, SET use remains a missed opportunity for the conservative management of claudication in the vast majority of patients regardless of payer types. Targeted strategies are needed to improve the integration of SET into care pathways for patients with claudication.