Regional variation in Medicare payments for medical imaging: radiologists versus nonradiologists.

OBJECTIVE: The purpose of this article was to study regional variation in Medicare Physician Fee Schedule (MPFS) payments for medical imaging to radiologists compared with nonradiologists. MATERIALS AND METHODS: Using a 5% random sample of all Medicare enrollees, which covered approximately 2.5 million Part B beneficiaries in 2011, total professional-only, technical-only, and global MPFS spending was calculated on a state-by-state and United States Census Bureau regional basis for all Medicare Berenson-Eggers Type of Service-defined medical imaging services. Payments to radiologists versus nonradiologists were identified and variation was analyzed. RESULTS: Nationally, mean MPFS medical imaging spending per Medicare beneficiary was $207.17 ($95.71 [46.2%] to radiologists vs $111.46 [53.8%] to nonradiologists). Of professional-only (typically interpretation) payments, 20.6% went to nonradiologists. Of technical-only (typically owned equipment) payments, 84.9% went to nonradiologists. Of global (both professional and technical) payments, 70.1% went to nonradiologists. The percentage of MPFS medical imaging spending on nonradiologists ranged from 32% (Minnesota) to 69.5% (South Carolina). The percentage of MPFS payments for medical imaging to nonradiologists exceeded those to radiologists in 58.8% of states. The relative percentage of MPFS payments to nonradiologists was highest in the South (58.5%) and lowest in the Northeast (48.0%). CONCLUSION: Nationally, 53.8% of MPFS payments for medical imaging services are made to nonradiologists, who claim a majority of MPFS payments in most states dominated by noninterpretive payments. This majority spending on nonradiologists may have implications in bundled and capitated payment models for radiology services. Medical imaging payment policy initiatives must consider the roles of all provider groups and associated regional variation.

Trends in lumbar puncture over 2 decades: a dramatic shift to radiology.

OBJECTIVE: The purpose of this study is to evaluate national trends in lumbar puncture (LP) procedures and the relative roles of specialty groups providing this service. MATERIALS AND METHODS: Aggregated claims data for LPs were extracted from Medicare Physician Supplier Procedure Summary master files annually from 1991 through 2011. LP procedure volumes by specialty group and place of service were studied. RESULTS: Between 1991 and 2011, the overall numbers of LP procedures increased, with a slight increase in diagnostic LP procedures (90,460 vs 90,785) and a marked increase in therapeutic LP procedures (2868 vs 6461) in Medicare fee-for-service beneficiaries. Although radiologists performed 11.3% (n = 10,533) of all LP procedures in 1991, they performed 46.6% (n = 45,338) in 2011. For diagnostic LPs, radiology (11.4% [n = 10,272] in 1991 and 48.0% [n = 43,601] in 2011) now exceeds emergency medicine, neurosciences, and all others as the dominant provider group. For therapeutic LP procedures, radiology now performs the second greatest number of LP procedures (9.0% [n = 261] in 1991 and 26.9% [n = 1737] in 2011). Although volumes remain small (< 10% of all procedures), midlevel practitioners have experienced over 100-fold growth for most services. The inpatient hospital setting remains the dominant site of service (71,385 in 1991 vs 44,817 in 2011: -37%), followed by procedures performed in the emergency department (297 in 1991 vs 26,117 in 2011: 8794%). CONCLUSION: Over the last 2 decades, LP procedures on Medicare beneficiaries have increased, with radiology now the dominant overall provider. Although this trend may have relatively negative financial implications for radiology practices in current fee-for-service payment models, it has the potential to cement radiology's more central position through direct involvement in patient care in emerging accountable care organizations.

Emergency department imaging: uncompensated services rendered by radiologists nationwide.

PURPOSE: The aim of this study was to examine characteristics of uncompensated services rendered by radiologists to emergency department (ED) patients. METHODS: Using deidentified billing claims for 2,935 radiologists from 40 states from 2009 through 2012, 18,475,491 services rendered to ED patients were identified. Analysis focused on the 133 of 830 procedure codes that comprised 99.0% (18,296,734) of all rendered services. The frequency, magnitude, and other characteristics of uncompensated (defined as zero payment) radiologist services were analyzed. National 2012 Medicare Physician Fee Schedule amounts were used to estimate service dollar values. RESULTS: Of 2,935 radiologists, 2,835 (96.6%) provided uncompensated care to ED patients, averaging $2,584 in professional services per physician per service month. Radiologists received no compensation at all for 28.4% of services (5,194,732 of 18,296,734). Just 8 procedure codes describing various chest, foot, and ankle radiographic and brain, abdominal and pelvic, and cervical spine CT examinations accounted for 51.0% of all imaging services rendered to ED patients. CT represented 31.2% of all services but accounted for 64.8% of uncompensated dollars. Although the uninsured received only 15.8% of all services, they accounted for 52.3% of all uncompensated services (2,714,506). CONCLUSION: More than 28% of services rendered by radiologists to ED patients are uncompensated, corresponding to $2,584 per month per physician. That frequency and magnitude could have patient access implications.

The scope and distribution of imaging services at critical access hospitals.

PURPOSE: The purpose of this study was to better understand the availability and scope of imaging services at critical access hospitals (CAHs) throughout the United States. METHODS: Recent American Hospital Association (AHA) annual survey data (containing 1,063 variables providing comprehensive information on organizational characteristics and availability of various services at 6,317 hospitals nationwide) and US census data were merged. Imaging survey data included mammography, ultrasound, CT, MRI, single photon emission CT, and combined PET/CT. Availability and characteristics of imaging services at the 1,060 CAHs in 45 states for which sufficient data were available were studied. RESULTS: Mammography, ultrasound, and some form of CT were the most widely available of all imaging services, but were available in all CAHs in only 13%, 33%, and 56% of all states, respectively. In no states were ≥64-slice CT, MRI, single photon emission CT, and combined PET/CT available in all CAHs. CONCLUSIONS: An overall scarcity of access to imaging services exists at CAHs throughout the United States. With 19.3% of the US population residing in rural areas and almost entirely dependent on CAHs for health services, the policy implications for imaging access could be profound. Further research is necessary to investigate the effect of imaging access on CAH patient outcomes.

The 2013 ACR Commission on Human Resources workforce survey.

BACKGROUND: The ACR Commission on Human Resources conducts an annual electronic survey during the first quarter of the year to better understand the present workforce situation for radiologists. METHODS: We used the Practice of Radiology Environment Database (PRED) to identify 2,067 practice leaders and asked them to complete an electronic survey developed by the Commission on Human Resources. The survey asked group leaders or their designates to report the number of radiologists they currently employ or supervise, the number hired in 2012, and the number they plan to hire in 2013 and 2016. The leaders were also asked to report the subspecialty area that was used as the main reason for hiring that physician. RESULTS: Of the 2,067 practice leaders surveyed, 22% responded, a figure corresponding to 23% of all practicing radiologists in the United States. These results showed that 54% of radiologists are in private practice and 46% are employed by various other entities. The current workforce consists of 21% general radiologists and 79% subspecialists. The largest areas of subspecialty include general interventionalists, neuroradiologists, and body imagers. In 2012, 1,407 radiologists were hired. The greatest number of radiologists hired involved general interventional radiologists, followed by general radiologists, body imagers, and those specializing in musculoskeletal radiology, neuroradiology, and breast imaging. In 2013, 1,526 job opportunities were projected and in 2016, 1,434 job opportunities. In 2013, the most sought-after individuals will be general radiologists, general interventionalists, breast imagers, neuroradiologists, musculoskeletal radiologists, and body imagers. CONCLUSION: Based on the data collected from the responding practices, the demand for hiring radiologists in 2013 will be similar to 2012. Each of the 1,200 residents who complete their training programs each year should have a position available, but the job may not necessarily be in the subspecialty, geographic area, or type of practice that the individual desires.