Objective:

This study analyzed national trends in thrombectomy reimbursement, utilization, and workforce composition to examine misalignments.

Background:

Mechanical thrombectomy is the standard of care for large-vessel occlusion strokes, but persistent fee schedule cuts and inflationary pressures may threaten sustainability. Resulting financial strain could limit hospital participation and delay timely access to thrombectomy care nationwide. The procedure is practiced by physicians from three different backgrounds leading to a diverse workforce composition.

Design/Methods:

We analyzed Medicare Part B data for CPT 61645 (intracranial mechanical thrombectomy, initial vessel). Physician Fee Schedule (2018-2025) facility rates were inflation-adjusted to July 2025 USD. Utilization data from National Summary Data Files (2018-2024) were used to calculate per-service payment (total payments÷allowed services). Outcomes included reimbursement changes, compound annual growth rate (CAGR), utilization trends, payment-volume correlations (both same-year and lagged), and segmented regression to identify inflection points. Workforce composition was assessed using CMS Medicare Physician & Other Practitioners data (2018 vs 2023), comparing specialty shares (radiology, neurosurgery, neurology) via χ² tests.

Results:

From 2018-2025, reimbursement declined 25.9% (CAGR -4.2%), while utilization increased 26.3% (2018-2024). Same-year payment–volume correlation was negative (r=-0.72, p=0.068), but a stronger lagged analysis was observed (r=-0.89, p=0.016), with lower reimbursement in year t predicting higher volume in t+1. Segmented regression identified 2020 as the key inflection, where reimbursement slope shifted from -$17.3/year to -$51.3/year (p<0.0001). Workforce distribution shifted significantly from 2018-2023 (χ² p<0.0001): radiologists (47% vs 39%), neurosurgeons (27% vs 35%), and neurologists (25% vs 25%).

Conclusions:

Despite utilization rising substantially, reimbursement declined steadily and accelerated after 2020, coinciding with pandemic disruptions and fee schedule cuts. Workforce analysis demonstrated a significant shift towards neurosurgery and away from radiology. These findings highlight a widening gap between declining reimbursement, which has not kept pace with expanding demand for procedures, and rising hospital costs, raising concerns about the sustainability and equitable access of thrombectomy programs.