"Hospital outpatient imaging has been migrating from private offices since about 2010," Dr. David C. Levin, of Thomas Jefferson University, told session attendees. "But that doesn't mean that radiologists still can't make private office ventures work."
What has caused the decline? A number of factors, including the closure of some offices due to reimbursement cuts, the Deficit Reduction Act (DRA) of 2005, the U.S. Centers for Medicare and Medicaid Services' (CMS) multiple procedure payment reduction (MPPR) policy, practice expense revaluation, increases in equipment utilization factors, and code bundling, to name a few.
Although imaging has been shifting away from private offices to hospital outpatient imaging departments (HOPDs) across all modalities -- with a particular drop in 2011, when CMS initiated code bundling for CTs of the abdomen and pelvis -- the most dramatic downward trends have come from reimbursement cuts to cardiology exams such as myocardial perfusion imaging (MPI) and transthoracic echocardiograms.
"Since 2010, there's been a progressive drop in cardiology private office use, with cardiologists closing their offices or selling their practices to hospitals," Levin said. "So private office utilization is definitely in jeopardy for cardiology, but not so much for radiology."
|Radiology Medicare utilization rates, all imaging (rate per 1,000 exams)|
|Cardiology Medicare utilization rates, all imaging (rate per 1,000 exams)|
Levin offered the following ideas to help private radiology offices make the most of their situation:
What's the bottom line? The benefit of private office imaging is that these practices can be much more agile in terms of charges than hospital outpatient departments, and that appeals to patients, Levin said.
"Patients are going to have higher and higher deductibles, and that's going to make them shop around for healthcare," he said. "If you can offer, say, an MR of the knee for $600, while the local hospital has it at $4,000, you can be sure that patients will come to you."