Nonradiologists outpace radiologists in skyrocketing use of ultrasound

CHICAGO - Ultrasound utilization by cardiologists grew more than three times as rapidly as use by radiologists between 1993 and 2001, according to research from Thomas Jefferson University in Philadelphia.

“And between 1993 and 2001, ultrasound utilization rates among other physicians grew almost twice as fast as it did among radiologists,” said Dr. David Levin of TJU.

To evaluate change in utilization of diagnostic ultrasound in recent years, the TJU-led study team searched the nationwide Medicare Part B database between 1993 and 2001, using all ultrasound CPT-4 codes except for ophthalmic ultrasound and supervision/interpretation codes. The ultrasound studies were categorized as general, vascular, breast, obstetrical, and echocardiography exams.

Employing standard Medicare physician specialty codes, the researchers then calculated utilization rates per thousand Medicare beneficiaries for radiologists, cardiologists, and other physicians for all codes in the five categories. Multi-specialty groups were excluded.

Overall, radiologist utilization of ultrasound climbed 25% from 132.9 per 1000 beneficiaries in 1993 to 166.3 per thousand in 2001. Cardiologist use increased by 87%, while utilization by other physicians was up 43% to 167 per thousand beneficiaries.

“Back in 1993, utilization rates among these three categories were kind of in the same ballpark, but as a result of this tremendous growth, particularly in echocardiography among cardiologists, there’s now a tremendous disparity,” Levin said. “Cardiologists do a lot more ultrasound now than radiologists do. Other physicians perform about exactly same amount of ultrasound studies as radiologists do.”

In the specific categories, radiologists performed 93.1 general ultrasound cases per 1000 beneficiaries in 2001 (up 1% from the 92.6 per thousand in 1993), and 55.5 vascular ultrasound cases per 1000 beneficiaries (up 85% from 30 per thousand in 1993).

Radiologists performed echocardiography studies at a rate of 4.3 per thousand in 2001, down 19% from the 5.3 rate in 1993. Obstetrical studies generated only 0.3 cases for radiologists, down 25% from 0.4 in 1993, Levin said.

For cardiologists, echocardiography utilization surged from 181 to 340.6 per thousand beneficiaries, up 88%, while vascular ultrasound climbed 72% from 8.6 to 14.8.

Echocardiography made up the largest category of utilization among nonradiologists, with 405.9 cases per thousand beneficiaries. They were, however, also active in vascular (64.9 per thousand in 2001), and general ultrasound (47.1) studies, Levin said.

Other physicians performed breast ultrasound studies at a rate of 1.1 per thousand in 2001, up 267% from the 0.3 rate in 1993.

“Even without echocardiography, utilization rates of all noncardiac ultrasound among all nonradiologists grew almost twice as fast as it did among radiologists,” Levin said. “Self-referral is a likely explanation for much of the excess growth that we’re seeing among nonradiologists.”

By Erik L. Ridley staff writer
December 1, 2003

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