Troy Brown
Jul 05, 2013
The percentage of patient encounters that result in imaging has decreased significantly and consistently nationwide, according to an analysis of Medicare Part B claims data from 2003 to 2011 and data from the Medical Expenditure Panel Survey (MEPS) from 2003 to 2010.
Martey S. Dodoo, PhD, from the Harvey L. Neiman Health Policy Institute in Reston, Virginia, and colleagues report their findings in the July issue of the Journal of the American College of Radiology.
The Deficit Reduction Act (DRA) of 2005 greatly limited payments for many imaging services. However, before 2006, spending on imaging had grown rapidly. It is unclear whether the DRA has affected use of imaging services with regard to concurrent and downstream patient care, the authors note. In addition, they continue, further reductions in physician payments for all services, including imaging, are likely, which could affect patient care.
In an attempt to look deeper than previous studies, which have focused mainly on Medicare use and costs, this study examines the actual care physicians provide and the decisions they make during patient visits.
According to data from Medicare Part B administrative claims made from 2003 to 2011, Medicare payments for imaging in elderly patients rose from $294 per enrollee in 2003 to $418 in 2006, decreased to $383 in 2007, and increased slightly before falling to $390 by 2011.
On the basis of data from the MEPS household component, a statistically significant downward trend was seen in the proportion of medical visits made by patients aged 65 years or older that resulted in imaging, going from 12.8% (95% confidence interval, 11.5% - 14.1%) in 2003 to 10.9% in 2006 (the year the DRA was enacted). In 2010, this percentage fell further to 10.6% (95% confidence interval, 9.7% - 11.4%).
On the basis of the household component of the MEPS, the average per patient spending on physician services for all elderly medical visits increased from approximately $3631 in 2003 to $4029 in 2007. Average expenses decreased in 2008 after enactment of the DRA but increased the next year to $5001, although they fell to $4388 in 2010.
The increase in medical imaging had already begun to decrease in all settings before the enactment of the DRA, the authors write.
In the physician office setting, program payments for imaging services grew by 17.8% per enrollee per year from 2003 to 2004. Growth was still positive from 2005 to 2006 but had declined to 10.0% per year by 2006.
In the inpatient setting, program payments to physicians for imaging services grew by 14.2% from 2003 to 2004 but then decreased by 3.6% from 2005 to 2006.
Information from Industry
Since the enactment of the DRA (2008 - 2011), program payments for imaging in the physician's office setting remained stable, with a 0% average annual growth (range, −3.8% to 4.7% per year). Program payments to physicians for imaging in inpatient settings saw a primarily downward growth trend from 2008 to 2011, with an average annual negative growth of −2.5% and a rapid decline (−11.0%) from 2010 to 2011.
"The relative decline in the proportion of clinical encounters involving medical imaging could be related to an overall increase in physician clinical encounters, a decline in the absolute frequency of medical imaging, or (and we believe likely) a combination of both," the authors write.
The authors urge researchers to use other national survey sources in addition to Medicare data when studying use trends. "During the period from 2003 through 2010, for which both Medicare Part B aggregated claims and MEPS and data were available, identified trends in the utilization of medical imaging were noticeably not parallel. This indicates that traditionally cited metrics — Medicare service units and spending — alone may not be satisfactory in completely understanding utilization trends," the authors conclude.
http://www.medscape.com/viewarticle/807440
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