Access to electrophysiologic care for Medicare beneficiaries across the United States: Travel distance and time to nearest clinician, 2013-2020.

BACKGROUND

Electrophysiologic care is increasingly a critical element of cardiovascular care, especially among older adults.

OBJECTIVE

We investigated access to common electrophysiologic procedures among Medicare beneficiaries in the United States (US).

METHODS

We used US Medicare Physician and Other Practitioners data (2013-2020) to identify centers providing pacemaker implantation and atrial fibrillation (AF) ablation, and linked it to county and zip code-level demographic data from the Agency for Healthcare Research and Quality to evaluate the density and trends in the number of centers across states and counties. For each US zip code, we determined the closest center where electrophysiologic procedures were performed and the travel duration using the Google Maps application programming interface. We also examined the association between sociodemographic factors and travel time to the nearest clinician using multivariable logistic regression models.

RESULTS

In 2020, 3022 Medicare providers performed pacemaker implantations across 1392 centers, and 1661 providers performed AF ablations across 852 centers. However, only 20% of US counties had facilities performing pacemaker implantation, and just 16% had sites offering AF ablation. In 45% of counties, individuals needed to drive ≥1 hour to reach a site for pacemaker implantation. For AF ablation, this number increased to 50%. Longer travel times were associated with non-urban zip codes, higher percentage of Hispanic residents, less than high school education, and median annual income <$59,000.

CONCLUSION

There are demographic and geographic disparities in access to interventional electrophysiologic care among Medicare beneficiaries in the US, with lower access among residents of rural areas and socio-economically disadvantaged groups.