Trends in Outpatient MRI Seem to Reflect Recent Reimbursement Cuts

PurposeTo determine whether recent reimbursement cuts have resulted in a shift of outpatient MRI from private offices to hospital outpatient departments (HOPDs); and to study office MRI utilization trends among radiologists and other specialists.MethodsThe Medicare Part B Physician/Supplier Procedure Summary Master Files were used. MRI codes were aggregated, and total MRI volumes from 2002 to 2012 were studied. Medicare place-of-service codes were used to identify studies performed in private offices and HOPDs and create trend lines. Specialty codes were used to categorize private office MRI users as radiologists, orthopedic surgeons, other physicians, and independent diagnostic testing facilities.ResultsMedicare office and HOPD utilization of MRI (all specialties) rose rapidly from 2002 to 2006, reaching 2,727,807 in offices and 2,355,641 in HOPDs. Thereafter, office volume steadily declined, whereas HOPD volume steadily increased. By 2012, more studies were done in HOPDs than in offices. Over the entire period from 2002 and 2012, office MRI volume among radiologists increased 27%, compared with 216% among orthopedic surgeons and 124% among other physicians.ConclusionsAlthough the majority of Medicare outpatient MRI studies had previously been performed in private offices, recent years brought a shift, with more now being performed in HOPDs. This change will increase costs to payers, because reimbursements to HOPDs are generally higher than those to offices. Although radiologists perform the majority of MRI exams that are conducted in private offices, the rate of growth for such exams from 2002 to 2012 was considerably higher among orthopedic surgeons and other physicians than among radiologists.     

Factors That Will Determine Future Utilization Trends in Diagnostic Imaging

Radiologists are facing uncertain times, and in this kind of environment, strategic planning is important but difficult. In particular, it is hard to know whether future imaging volume will increase, decrease, or stay approximately the same. In this article, the authors discuss a variety of factors that will influence imaging use in the coming years. Some factors will tend to increase imaging use, whereas others will tend to curtail it. Some of these factors will affect individual groups differently, depending on their locations and the circumstances of their practices. Radiologists would be well advised to become aware of and consider these factors as they go about their planning processes.     

The Value-Added Services of Hospital-Based Radiology Groups

The authors discuss the ways in which a single, cohesive, on-site radiology group adds value to both the processes of patient care and the success of the hospital. The value-added services fall into 6 categories: (1) patient safety, (2) quality of the images, (3) quality of the interpretations, (4) service to patients and referring physicians, (5) cost containment, and (6) helping build the hospital's business. If the hospital allows its radiology department to become fragmented by the intrusion of other specialists or teleradiology companies in remote locations, most of these added values would be lost, and chaos could ensue.     

The Percent Share of All Medicare Payments to Physicians That Is Attributable to Noninvasive Diagnostic Imaging

PurposeTo ascertain the proportion of all Medicare payments to physicians under the Medicare Physician Fee Schedule (PFS) that is attributable to noninvasive diagnostic imaging (NDI).Materials and MethodsThe Medicare Part B Physician/Supplier Procedure Summary Master Files for 2003 to 2015 were the data source. Total approved payments to physicians for all medical services were determined each year. We then selected all procedure codes for NDI and determined aggregate approved payments to physicians for those codes. Also, Medicare’s provider specialty codes were used to define payments to four provider categories: radiologists, cardiologists, all other physicians, and independent diagnostic testing facilities together with multispecialty groups (in this category, the specialty of the actual provider cannot be determined).ResultsTotal Medicare-approved payments for all physician services under the PFS increased progressively from $92.73 billion in 2003 to $132.85 billion in 2015. In 2003, the share of those payments attributable to NDI was 9.5%, increasing to a peak of 10.8% in 2006, but then progressively declining to 6.0% in 2015. All four provider categories saw the same trend pattern—a peak in 2006 but then decline thereafter. By 2015, the shares of total PFS payments to physicians that were attributable to NDI were as follows: radiologists 3.2%, cardiologists 1.2%, all other physicians 1.2%, independent diagnostic testing facilities or multispecialty groups 0.4%.ConclusionThe proportion of Medicare PFS spending on physician services that is attributable to NDI has been declining in recent years and is now quite small.     

National Trends in the Utilization of Skeletal Radiography From 2003 to 2015

PurposeExamine recent trends in the use of skeletal radiography and assess the roles of various nonradiologic specialties in the interpretations.MethodsMedicare Part B fee-for-service claims data files from 2003 to 2015 were analyzed for all Current Procedural Terminology, version 4 (CPT-4) procedure codes related to skeletal radiography. The files provide examination volume, and we calculated utilization rates per 1,000 Medicare beneficiaries. Medicare’s physician specialty codes were used to determine the specialties of the providers. Total utilization rate trends were analyzed, as well as those for radiologists and nonradiologists. We determined which nonradiologist specialties were the highest users of skeletal radiography. Medicare place-of-service codes were used to identify the locations where the services were provided.ResultsThe total utilization rate per 1,000 of skeletal radiography within the Medicare population increased 9.5% from 2003 to 2015. The utilization rate for radiologists increased 5.5% from 2003 to 2015 versus 11.1% for nonradiologists as a group. Among nonradiologist specialties in all health care settings over the study period, orthopedic surgeons increased 10.6%, chiropractors and podiatrists together increased 14.4%, nonphysician providers (primarily nurse practitioners and physician assistants) increased 441%, and primary care physicians’ rate decreased 33.5%. Although radiologists do almost all skeletal radiography interpretation in hospital settings, nonradiologists do the majority in private offices. There has been strong growth in skeletal radiography in emergency departments, but a substantial drop in inpatient settings.ConclusionsThe utilization of skeletal radiography has increased more rapidly among nonradiologists than among radiologists. This raises concerns about self-referral and quality.