With medical imaging reimbursement and use declining in the U.S., radiologists are increasingly forced to articulate the value of imaging services.
Usage, reporting requirements are hot topics
During the Radiological Society of North America's annual meeting last week in Chicago, the authors of a new self-referral study said that reducing unnecessary imaging exams would better serve patients and the broader healthcare system. Further reductions in imaging reimbursement would only limit access, they say.
“There are a limited number of healthcare dollars and we need to spend them as wisely as possible,” says Dr. Ben Paxton, radiology resident at Duke University Medical Center and a co-author of the unpublished study.
Paxton and Dr. Ramsey Kilani, a senior author of the study, also said they support stricter reporting requirements, including the possibility of legislation, that would require increased transparency around the ownership of imaging equipment and the appropriateness of its use.
Concern about the tie between spending on imaging and the financial interest of physicians' offices prompted the Government Accountability Office in 2008 to question “whether Medicare's physician payment policies embody financial incentives for physicians to overuse imaging services.”
The self-referral study found that orthopedic physicians who own or lease MRI equipment are more likely to refer patients for scans that may be unnecessary. The researchers looked at 500 consecutive diagnostic lumbar spine MRI exams ordered by two orthopedic physician groups in a large metropolitan city on the East Coast. Forty-two percent of the patients who had exams at the group with a financial interest in the MRI equipment had negative scans, compared with 23% of patients whose scans were ordered by the group with no financial interest. There was no significant difference between the groups in the number of abnormalities in positive scans.
An increasing number of non-radiologists own or lease MRI equipment even as reimbursement for imaging services has declined. The number of MRI scans performed by non-radiologists who either own or lease the equipment increased by 254% from 2000 to 2005, compared to the 83% growth rate for radiologists, according to a 2008 study in the Journal of the American College of Radiology. Orthopedic surgeons were the most active in ordering MRI exams among non-radiologists. In 2005, they performed 161,296 Medicare exams billed to Medicare, more than twice as often as the neurologists (63,363 Medicare exams), the specialists next most inclined to order MRIs.
The Deficit Reduction Act implemented reimbursement reductions for imaging services in 2006, which led to a drop in imaging spending for Medicare beneficiaries. An analysis of Medicare data released by the Medical Imaging and Technology Alliance last month found that Medicare spending on imaging for each beneficiary fell 13.2% from 2006 to 2010. The alliance said that Medicare reimbursements for imaging procedures have been cut six additional times since the Deficit Reduction Act.
“The issue now is one of access to imaging and overall costs to the system,” Kilani said during the RSNA news conference.
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