MedPAC: Imaging grows slower than other medical services

2017 05 04 10 02 04 942 Capitol Hill2 400

The Medicare Payment Advisory Commission (MedPAC) may have published its latest report to the U.S. Congress on March 15, but its findings and recommendations aren't new: The commission continues to focus growth in imaging utilization that occurred more than a decade ago, despite a relatively small volume increase between 2016 and 2017.

The volume of medical imaging procedures per Medicare beneficiary grew only 1.3% between 2016 and 2017, lagging growth in other medical services. But growth in imaging utilization expanded 75% from 2000 and 2017.

"While volume growth for imaging in 2017 was slightly lower than the average increase for all services and follows a slight decrease from 2012 to 2016, use of imaging services remains much higher than it was in 2000," MedPAC said. "Cumulative growth in the volume of imaging per beneficiary from 2000 to 2017 totaled 75%, which was much higher than cumulative growth during the same period for major procedures and [evaluation and management] services (47% and 45%, respectively)."

In addition, increases in imaging volume in 2017 were higher for certain types of imaging than for others, MedPAC pointed out. In 2017, CT volume grew by 4.9%, compared with average annual volume growth of 2.7% from 2012 to 2016. MRI volume in 2017 grew by 2.3%, compared with average annual volume growth of 1.3% from 2012 to 2016, the commission said.

Still, the commission acknowledged that the 1.3% increase in imaging in 2017 was lower than the average increase for all healthcare services, and it follows decreases from 2012 to 2016. In fact, the average annual change in imaging volume per beneficiary had a negative percent increase.

Changes in Medicare imaging volume
Change in imaging volume per beneficiary, 2016-2017 1.3%
Average annual change in imaging volume per beneficiary, 2012-2016 -0.2%
Change in units of service per beneficiary, 2016-2017 1.4%
Average annual change in units of service per beneficiary, 2012-2016 0.2%
Percent of 2017 allowed charges 11.4%
Source: MedPAC analysis of claims data for 100% of Medicare beneficiaries.

To address concerns about imaging overuse, organizations such as the American Board of Internal Medicine (ABIM) have developed campaigns to identify overused procedures, MedPAC said. The latest version of the ABIM's Choosing Wisely guideline includes more than 550 tests considered overused by more than 80 specialty societies. And the U.S. Centers for Medicare and Medicaid Services (CMS) is developing a program that will require clinicians to use clinical decision-support software when they order advanced diagnostic imaging services for beneficiaries, MedPAC said.

Finally, MedPAC concluded that physician reimbursement is adequate and should be updated as usual according to the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) -- which for 2020 recommends no payment increase.

"Overall, access to clinician services for Medicare beneficiaries appears stable and comparable with that for privately insured individuals. ... Therefore, the commission does not see a reason to diverge from the current-law policy of no update for 2020," MedPAC wrote.

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