Document Type

Article

Publication Title

JVS-Vascular Insights

Abstract

Background: Office-based laboratories (OBLs) have expanded rapidly since the introduction of Centers for Medicare & Medicaid Services (CMS) reimbursement for outpatient vascular interventions in 2008, driven by advances in endovascular technology and cost effectiveness. Alongside ambulatory surgery centers (ASCs), OBLs enable minimally invasive vascular procedures to be performed safely outside hospital settings with same-day discharge. Over the past decade, peripheral vascular interventions (PVIs) have increasingly shifted to outpatient environments, with OBLs demonstrating the most rapid growth. Despite this transition, national trends and geographic variation in OBL growth remain incompletely characterized. This study examined the longitudinal growth and geographic distribution of vascular OBLs in the United States from 2010 to 2023.

Methods: We analyzed all outpatient lower extremity PVIs performed from 2010 to 2023 using 100% fee-for-service Medicare claims data. Endovascular PVIs were identified by procedural codes and categorized by treatment modality and arterial segment. Facilities were classified as hospitals, ASCs, or OBLs. OBLs were further categorized as private, hospital affiliated, or multispecialty based on CMS records and practice websites and designated as vascular if a vascular surgeon was listed. State-level OBL densities were normalized to the population aged $65 years using 2021 US Census data and visualized geographically using state-level heat maps.

Results: Between 2010 and 2023, the number of hospitals performing PVIs decreased by 52.9%, and the number of ASCs increased by 53.3%. OBLs increased from 1209 in 2010 to 1409 in 2015, followed by a plateau, resulting in a net increase of 12.9% by 2023. Over time, the number of annual OBL openings decreased, and year-to-year facility persistence improved from 59.3% to 81.8%. In 2021, OBL density varied noticeably by state, with the highest concentrations in Texas, Arizona, and Florida, and substantially lower densities in much of the Midwest and New England. Private vascular OBLs predominated in low-regulation states, and hospital-affiliated OBLs were uncommon and geographically limited.

Conclusions: The shift of PVIs to OBLs reflects a broader movement toward outpatient, minimally invasive care that enhances physician autonomy. However, OBL growth has been uneven and increasingly constrained by rising operating costs and declining inflation-adjusted CMS reimbursements. Geographic variation in OBL prevalence suggests that state policy environments play a critical role, with higher densities observed in less restrictive states. Long-term sustainability of office-based vascular care will likely require reimbursement policies that account for inflation and regulatory frameworks that support physician-led outpatient practice.

DOI

10.1016/j.jvsvi.2026.100442

Publication Date

7-10-2026

Keywords

Office-based laboratories, Outpatient vascular surgery, Peripheral vascular interventions

ISSN

2949-9127

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