Paying Accurately For Imaging Services In Medicare

Winter, Ariel; Ray, Nancy

doi:10.1377/hlthaff.27.6.1479

Cited by 25 publications

(11 citation statements)

References 3 publications

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“…While this debate continues, our study finds that the number of U.S. hospitals providing CTC is modest but growing, from 13% in 2005 to 17% in 2008. Our findings are consistent with previous studies showing that imaging services are expanding [15, 16]. However, the rapid growth of imaging services is often attributed to inaccuracies (i.e., overpayment) in Medicare reimbursement for those services.…”

Section: Discussionsupporting

confidence: 92%

Adoption of CT Colonography by US Hospitals

McHugh

Osei-Anto

Klabunde

et al. 2011

Journal of the American College of Radiology

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Purpose-Computed tomographic colonography (CTC) is a new non-invasivetechnology proposed as an option for colorectal cancer screening. The purpose of this study was to identify the percent of U.S. hospitals that offered CTC between 2005 and 2008 and factors that motivated or impeded adoption.Methods-We analyzed data on the provision of colorectal cancer screening services by nonfederal, general hospitals using the 2005 -2008 American Hospital Association Annual Surveys. Additionally, in 2009, we conducted exploratory interviews with representatives from radiology departments at nine hospitals -six that provided CTC and three that did not.Results-In 2008, 17% of hospitals offered CTC, up from 13% in 2005. Sixty-nine percent of hospitals that offered CTC in 2008 also offered optical colonoscopy services. Factors motivating adoption of CTC included a desire to provide an alternative screening option for frail, elderly patients and patients with a failed optical colonoscopy; long waits for optical colonoscopy; and promising evidence on CTC published in peer-reviewed literature. Lack of reimbursement was a commonly-cited barrier.Conclusion-Growth of CTC services at U.S. hospitals occurred even in the absence of Medicare coverage or agreement among national guideline-setting organizations regarding CTC's use in screening. Almost one-third of hospitals that offer CTC do not offer optical colonoscopy, and may not be prepared to provide adequate follow-up for patients with failed CTCs.

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Section: Discussionsupporting

confidence: 92%

Adoption of CT Colonography by US Hospitals

McHugh

Osei-Anto

Klabunde

et al. 2011

Journal of the American College of Radiology

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“…It has been well documented that use of diagnostic imaging technology grew rapidly in the early 2000s [1-5]. The rate of growth in imaging use was substantial, with a 70% cumulative increase in utilization between 2000 and 2007 among Medicare beneficiaries, compared to a less than 40% increase for all physician services [2].…”

Section: Introductionmentioning

confidence: 99%

National trends in advanced outpatient diagnostic imaging utilization: an analysis of the medical expenditure panel survey, 2000-2009

Lang¹,

Huang²,

Lee

et al. 2013

BMC Med Imaging

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BackgroundConcerns have been raised regarding growth in advanced diagnostic imaging use. This study evaluated trends in national outpatient MRI/CT utilization rates during 2000-2009 and factors associated with utilization.MethodsThis retrospective database analysis used data on all respondents in the nationally representative U.S. Medical Expenditure Panel Survey (MEPS) during 2000-2009. Visits involving advanced diagnostic imaging were identified based on self-reported use of MRI or CT tests at emergency departments, office-based medical providers, and outpatient departments. The imaging utilization rate was defined as the number of outpatient visits with MRI/CT per 1,000 person-years. Results were weighted to create nationally representative estimates at the person-year level for each year and the pooled 10-year period. A multivariate logistic regression was estimated to identify predictors of imaging use.ResultsA total of 319,246 person-years were included in the analysis. MRI/CT utilization rates increased from 64.3 to 109.1 per 1,000 person years from 2000 to 2009, with older persons, females and Medicare enrollees having higher rates of use. Growth in imaging slowed in recent years; the average annual decline in the imaging growth rate was larger than that for all outpatient services (4.7% vs. 0.9%). The percentage of respondents with MRI/CT use (6.7% during 2000-2009) also increased at a slower rate in later years and declined during 2007-2009. The average number of MRI/CT visits among imaging users was steady at about 1.5 visits during 2000-2009. Age, female gender, White race, HMO participation, and all payer types (vs. uninsured) were significant predictors of imaging use. Compared to 2005, years 2000-2003 were associated with a significantly lower likelihood of imaging use, while years 2004-2009 were not significantly associated, suggesting a slow-down in later years.ConclusionsGrowth in advanced imaging utilization appears to have slowed in recent years, a finding of potential interest to policy-makers and payers.

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“…I maging has been shown to be the most rapidly growing of all physician services in the Medicare program in recent years, especially in physicians' private offices [1][2][3][4] There have been widely expressed concerns about this trend as a major cost driver. [5][6][7][8][9][10][11] As a result, provisions to curb imaging growth in private offices were incorporated into the Deficit Reduction Act (DRA) of 2005, which took effect 1 January 2007. 1 Prior to that date, the technical-component portion of Medicare reimbursements for outpatient high tech (or advanced) imaging such as magnetic resonance imaging (MRI), computed tomography (CT), and nuclear scanning (including positron emission tomography, or PET) were based on two separate fee schedules, depending on where the exam was performed.…”

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confidence: 99%

Physician Orders Contribute To High-Tech Imaging Slowdown

2010

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The utilization rate of advanced diagnostic imaging (magnetic resonance imaging, computed tomography, and nuclear medicine) in Medicare outpatients rose 72.7 percent between 2000 and 2005, sparking concern among policymakers. However, analysis of discretionary use of these exams indicates that their use largely stabilized after 2005. Some have credited the Deficit Reduction Act of 2005, which sharply reduced reimbursements for advanced imaging done in physicians' offices. But the fact that the leveling was more pronounced in hospital outpatient facilities than in physicians' offices indicates that the explanation lies elsewhere. More likely, there has been a change in physicians' ordering patterns, possibly due to the influence of radiology business management companies (RBMs) and imaging guidelines promulgated by specialty societies.

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Paying Accurately For Imaging Services In Medicare

Cited by 25 publications

References 3 publications

Adoption of CT Colonography by US Hospitals

Adoption of CT Colonography by US Hospitals

National trends in advanced outpatient diagnostic imaging utilization: an analysis of the medical expenditure panel survey, 2000-2009

Physician Orders Contribute To High-Tech Imaging Slowdown

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