Recent reimbursement changes and their effect on hospital and private office use of myocardial perfusion imaging.

Purpose: The aims of this study were to examine recent trends in the utilization of radionuclide myocardial perfusion imaging (MPI) and to reflect on their causes and their implications for radiologists.

Methods: Nationwide Medicare Part B databases for 2000 through 2010 were used. Codes for primary MPI studies (including PET) were selected.

The recent downturn in utilization of CT: the start of a new trend?

Purpose: The aim of this study was to examine recent CT utilization trends to ascertain if growth is still occurring.

Methods: The nationwide Medicare Part B databases for 2000 through 2010 were used. All Current Procedural Terminology, fourth ed, codes for diagnostic CT (including CT angiography) were selected.

The sharp reductions in medicare payments for noninvasive diagnostic imaging in recent years: will they satisfy the federal policymakers?

Purpose: The aim of this study was to examine recent trends in Medicare reimbursements for noninvasive diagnostic imaging (NDI).

Methods: The Medicare Part B databases for 2000 to 2010 were used. For each procedure code, these files provide payment and other data.

Percutaneous needle vs surgical breast biopsy: previous allegations of overuse of surgery are in error.

Purpose: A recent paper in the American Journal of Surgery reported that surgery is used for 30% of breast biopsies, an excessive number. The investigators' stated biopsy volume included Current Procedural Terminology(®) code 19125 ("excision of breast lesion identified by preoperative placement of radiological marker, open"). However, this code may often be used when a surgeon's primary intention is not biopsy but rather excision of a lesion.

Trends in the utilization of outpatient advanced imaging after the deficit reduction act.

Purpose: After the Deficit Reduction Act (DRA) took effect in 2007, there was concern that private office-based imaging facilities would close, that advanced imaging would shift to less convenient hospital-based facilities, and that access to advanced imaging might be restricted. The aim of this study was to see if these developments occurred during the years after the DRA.

Methods: Using Medicare data, outpatient CT, MRI, and nuclear medicine trends before and after the DRA were studied.

Noncardiac point-of-care ultrasound by nonradiologist physicians: how widespread is it?

Purpose: The use of point-of-care (POC) ultrasound by nonradiologist physicians has recently been advocated. The aim of this study was to see how widespread this practice is.

Methods: The Medicare Part B databases for 2004 to 2009 were used.

The lack of growth in use of coronary CT angiography: is it being appropriately used?

Objective: The purpose of this article is to study recent utilization trends in coronary CT angiography (CTA) and compare them with radionuclide myocardial perfusion imaging (MPI), a competing procedure.

Materials And Methods: The nationwide Medicare Part B databases were used to determine utilization rates per 100,000 beneficiaries. Rates for coronary CTA were studied from 2006 (the first year Current Procedural Terminology codes were available for this procedure) through 2008.

The effect of self-referral on utilization of advanced diagnostic imaging.

Objective: This article reviews the evidence on the relationship between recent increases in utilization of diagnostic imaging and self-referral. The evidence shows that self-referral invariably leads to higher utilization and the attendant higher costs.

Conclusion: Because most physicians do not own advanced imaging equipment, their own best interests are being thwarted by the practice of self-referral.

Outsourcing to teleradiology companies: bad for radiology, bad for radiologists.

Outsourcing night and weekend call to teleradiology companies has become a common practice among private radiology groups. While this may lead to an easier lifestyle, the authors discuss the serious negative consequences for radiologists and the specialty as a whole. These include the likelihood of commoditization of the field, lowering of fees, displacement from hospital contracts and outpatient reading contracts, greater encroachment by other specialties, and lowering of quality.

Medicare payments for noninvasive diagnostic imaging are now higher to nonradiologist physicians than to radiologists.

Purpose: Radiologists have always been considered the physicians who "control" noninvasive diagnostic imaging (NDI) and are primarily responsible for its growth. Yet nonradiologists have become increasingly aggressive in their performance and interpretation of imaging. The purpose of this study was to track overall Medicare payments to radiologists and nonradiologist physicians in recent years.

Bending the curve: the recent marked slowdown in growth of noninvasive diagnostic imaging.

Objective: The purpose of this article is to determine whether there has been any change in the rapid growth pattern that has characterized noninvasive diagnostic imaging in recent years.

Materials And Methods: The annual nationwide Medicare Part B databases were used. All Current Procedural Terminology codes for discretionary noninvasive diagnostic imaging were identified.

A prior authorization program of a radiology benefits management company and how it has affected utilization of advanced diagnostic imaging.

Radiology benefits management companies have evolved in recent years to meet the need to control the rapid growth in advanced diagnostic imaging. The Obama administration and other key policymakers have proposed using them as a cost-control mechanism, but little is known about how they operate or what results they have produced. The main tool they use is prior authorization.

Physician orders contribute to high-tech imaging slowdown.

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.

The disproportionate effects of the Deficit Reduction Act of 2005 on radiologists' private office MRI and CT practices compared with those of other physicians.

Purpose: The Deficit Reduction Act of 2005 (DRA) sharply reduced technical component payments for private office magnetic resonance imaging (MRI) and computed tomographic (CT) imaging. Although radiologists have no control over referrals, nonradiologist physicians (NRPs) can potentially make up for revenue shortfalls by self-referring more examinations. The purpose of this study was therefore to compare the effects of the DRA on the in-office MRI and CT practices of radiologists and NRPs.

Endovascular repair vs open surgical repair of abdominal aortic aneurysms: comparative utilization trends from 2001 to 2006.

Purpose: Within the past few years, endovascular aneurysm repair (EVAR) has come into use for the treatment of abdominal aortic aneurysms (AAAs). In many cases, EVAR has the potential to replace traditional open surgical repair (OSR), which is more invasive, risky, and expensive. The aim of this study was to determine to what extent EVAR is replacing OSR, whether the frequency of treatment is increasing with the advent of the less invasive approach, and which specialties are performing the procedures.

Recent payment and utilization trends in radionuclide myocardial perfusion imaging: comparison between self-referral and referral to radiologists.

Purpose: The aim of this study was to examine the effects of self-referral by comparing recent trends in payments and utilization rates for radionuclide myocardial perfusion imaging (MPI) among radiologists and cardiologists between 1998 and 2006.

Materials And Methods: Nationwide Medicare Part B claims databases for 1998 through 2006 were used. The 4 primary MPI codes were selected.

Recent shifts in place of service for noninvasive diagnostic imaging: have hospitals missed an opportunity?

Purpose: The aim of this study was to examine recent shifts in place of service for noninvasive diagnostic imaging (NDI) and determine whether hospitals have lost business to private outpatient imaging facilities.

Method And Materials: The nationwide Medicare Part B databases for 1996 through 2006 were used, and all Current Procedural Terminology((R)), fourth edition, codes for NDI were studied. Utilization rates per 1,000 Medicare beneficiaries were calculated.