U.S. radiologists have long swapped stories of how their imaging procedures were raided by other specialists. The takeover tales have been largely local -- a radiology group losing its cardiac imaging business to cardiologists here, emergency room physicians reading x-rays and ultrasounds there. But researchers at Thomas Jefferson University Hospital in Philadelphia backed up the anecdotes with cold, hard numbers. They did it by reviewing several years’ worth of Medicare data in an effort to determine how much ground radiologists have actually lost.
Dr. Vijay Rao presented the work of her and her colleagues at the RSNA 2001 scientific assembly in Chicago. Rao’s group confined its analysis to solely noninvasive diagnostic imaging (NDI), and assessed the extent of self-referral for these procedures by nonradiologist physician providers during a six-year interval.
The team compared data from the 1993 and 1999 U.S. Medicare Part B databases by reviewing 465 category 4 current procedure terminology (CPT-4) codes from 23 NDI categories for both years. The physician providers were then categorized as radiologists or nonradiologists, and each group’s respective utilization rates per 1,000 Medicare beneficiaries for each year were determined.
"We excluded 8.5% of the claims because they came from multispecialty groups in which the specialty of the interpreting physician could not be determined," Rao said.
The data analysis revealed that the 1993 utilization rate of NDI by radiologists was 2,163 per 1,000 Medicare beneficiaries, and the utilization rate by nonradiologists was 21.7% (803 per 1,000) of the total exams performed. However, by 1999 only 2,072 per 1,000 Medicare beneficiaries who underwent NDI procedures were performed by a radiologist. During the same interval, the nonradiologists’ share of NDI procedures climbed to a 32.2% share of all performed studies (985 per 1,000).
"The utilization rate of NDI by radiologists declined 4.2% during the 6-year interval, while the utilization rate by nonradiologists increased by 22.7%," said Rao.
Rao went on to reveal the research group’s discovery that the growth of NDI utilization by nonradiologists was even higher in five categories of the reviewed data. Cardiovascular nuclear medicine, echocardiography, general ultrasound, vascular ultrasound, and skeletal radiography saw a 32.9% increase in utilization by nonradiologists, yet only a 0.2% increase by radiologists during the six-year interval.
Although radiologists still perform approximately two-thirds of the NDI studies in the U.S., their share decreased 5% between 1993 and 1999. However, the rate among nonradiologists increased substantially.
Nonradiologist ownership of modalities may provide a strong incentive to self-refer. Rao noted that self-referring physicians who operated their own equipment utilized imaging studies two to eight times more frequently than physicians who referred their patients to a radiologist.
"At a time when policymakers are concerned about utilization of expensive medical technology, it appears that the existence of self-referral situations is a potent factor driving utilization increases," Rao observed.
By Jonathan S. BatchelorAuntMinnie.com staff writer
December 27, 2001
Related Reading
Turf Wars in Radiology, Part III: All is not lost in nuclear cardiology, August 31, 2001
Turf Wars in Radiology, Part I: Rads, attendings duke it out in the ER, August 10, 2001
Radiology's raided turf: three views from the field, March 20, 2001
Specialists spar over who should treat peripheral vascular disease, November 17, 2000
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