Abstract 4139419: US National Trends in left atrial appendage occlusion volume and open payments to operators

Background: Left atrial appendage occlusion (LAAO) was first performed among Medicare beneficiaries in 2017 and has grown rapidly in popularity. Payments from device manufacturers to physicians have been shown to correlate with other procedures, which are now publicly available. We report trends of LAAO in Medicare patients, and the relationship between procedure volume and manufacturer payment. Methods: We linked Medicare procedural data with Open Payments data via NPI number and identified physicians performing ≥ 1 LAAO between 2017 and 2021. Baseline physician information, including sex, operating location, and specialty, was extracted from CMS registries. Payment data were highly skewed, and winsorized at the 95 th percentile and compared to procedural volume. Results: The number of LAAO procedures increased from 6069 procedures in 2017 to 29083 in 2021 and 15.695 to 79.994 per 100,000 beneficiaries nationally. Across states, the median rate of implants 46.151 (IQR 33.765 – 62.271) per 100,000 beneficiaries, with Nebraska having the highest rate at 255.269 per 100,000 beneficiaries (Figure 1). The number of operators implanting LAAO devices increased from 286 (97.6% male) to 1003 (96.6% male). Roughly 49% of operators are licensed as electrophysiologists and 47% as interventional cardiologists. Total payments to physicians varied widely (median $ 3179.12, IQR 1703.16 – 9000.42) with >99% of operators receiving compensation from the LAAO device company; there is no clear relationship between compensation from the manufacturer and LAAO volume (r 2 =0.132) ( Figure 2 ). Conclusions: LAAO has seen dramatic growth in volume of procedures and operators nationally, with substantial regional variation. While almost all LAAO operators received compensation from the primary LAAO device company, there is no correlation between payment amount and procedural volume.