Variation in Canalith Repositioning Procedure Use Among Medicare Beneficiaries: Understanding the Role of Geographic Region and Provider Specialty.

Zuniga, Steven A; Marmor, Schelomo; Adams, Meredith E

OBJECTIVE Clinical practice guidelines recommend canalith repositioning procedures (CRPs) for the management of benign paroxysmal positional vertigo (BPPV). As only 10 to 20% of affected individuals receive CRPs, there is concern for guideline adherence and knowledge dissemination to relevant medical specialties. This study aimed to characterize patterns of CRP utilization over time, across all United States regions, and by provider specialty. STUDY DESIGN Cross-sectional analysis with time trends of CRP claims in the Centers for Medicare and Medicaid Service Provider Utilization and Payment database, 2012 to 2017. SETTING National administrative claims data. PATIENTS Fee-for-service Medicare beneficiaries. INTERVENTIONS Canalith repositioning procedures. MAIN OUTCOME MEASURES CRP utilization was analyzed by year, hospital referral region (HRR), and provider specialty. RESULTS From 2012 to 2017, 253,894 CRPs were performed on 146,139 Medicare beneficiaries and CRP utilization increased 80%. CRP use varied widely by geographic region. In 2017, CRP use per 100,000 beneficiaries varied 113-fold across HRRs (range, 6.0-701.8, interquartile range, 68.4, extremal ratio, 116.9). Most CRPs were performed by otolaryngologists (50.9%) and physical therapists (34.3%) with few by primary care providers (1.3%). CONCLUSIONS CRP utilization increased substantially suggesting improved dissemination and implementation of BPPV management guidelines. Nevertheless, wide geographic and provider-level variation remained, signifying non-uniform provider practices and access to care. Care for BPPV may thus be improved through education and incentivization of a broader range of providers.