Study confirms imaging's shift from offices to hospitals

By Kate Madden Yee, staff writer

December 12, 2014 -- As policymakers attempt to curb healthcare costs, the use of advanced imaging -- MR, nuclear medicine, and CT -- has been shifting from private offices to hospital outpatient departments. So how might this trend affect patients?

Researchers from Thomas Jefferson University addressed the question at the recent RSNA 2014 meeting.

"Concern has been expressed that reduced reimbursements and other factors might lead to closure of offices and a shift [of advanced imaging] to higher-cost hospital outpatient departments," said presenter Dr. Bhavik Patel. "We chose to study recent outpatient imaging trends in private offices and hospital outpatient departments to determine if any shifting has occurred between the two."

Patel and colleagues Dr. David C. Levin, Laurence Parker, PhD, and Dr. Vijay Rao used data from the Medicare Physician/Supplier Procedure Summary Master Files for 2000 to 2012. They culled CPT codes for MR, echocardiography, nuclear medicine, ultrasound, and CT and calculated procedure use rates per 1,000 Medicare beneficiaries for each year, as well as identified where the exams were performed.

The total utilization rate per 1,000 beneficiaries for all of these advanced imaging exams in private offices grew from 415 in the year 2000 to 874 in the peak year of 2008, for a growth rate of 111%, the group found. The rate then dipped sharply to 503 in 2011, a decrease of 42% -- which Patel and colleagues attributed to code bundling in echocardiography in 2009, nuclear cardiac exams in 2010, and abdominal/pelvic CT in 2011.

Even though there was no further code bundling in 2012, the downward trend for all of these exams in private offices continued, from 503 exams per 1,000 Medicare beneficiaries to 475.

What about hospitals?

So what happened in hospital outpatient departments? The total rate for all of these exams rose from 391 per 1,000 beneficiaries in 2000 to 523 in 2008, for an increase of 34%. This was followed by a decline to 418 exams per 1,000 in 2011, again because of code bundling, Patel said. But in 2012, things changed.

"In contrast to what happened in offices, the hospital outpatient department rate for these imaging procedures increased from 418 per 1,000 beneficiaries to 426," he said. "The ratio of private office to hospital outpatient department advanced imaging was 1.67 in 2008, declining to 1.11 in 2012."

Similar shifts from offices to hospital outpatient departments occurred in MR, echocardiography, and nuclear medicine, as well as ultrasound and CT, although the trend shift for these last two modalities was less dramatic, Patel and colleagues found.

Imaging procedure ratio, office to hospital outpatient
  2008 2012
MR 1.12 0.93
Echocardiography 3.62 1.71
Nuclear medicine 2.59 1
Ultrasound 1.82 1.74
CT 0.54 0.47

What does the trend suggest? Its effects on healthcare costs and patient care may be mixed, Levin told

"This kind of shift of high-tech imaging away from private imaging facilities and into hospital settings is bad for two reasons," he said. "First, it drives up costs to the payors because they typically pay more to hospitals than to offices for advanced imaging. That in turn will lead to higher premiums for patients. Second, the closure of some radiology offices will lead to reduced access for patients. But, on the other hand, it could create an opportunity for more-efficient practices to open up new offices to replace facilities that have closed, which payors would probably welcome."

Copyright © 2014

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