CHICAGO - In an era of declining professional payments, how can radiologists maximize their Medicare reimbursements? By focusing their practices, according to research presented at the RSNA 2018 meeting.
"Focusing one's practice leads to more efficiency and, therefore, more productivity," presenter Dr. Paul Yi of Johns Hopkins University told AuntMinnie.com.
While demand for imaging services has increased due to greater healthcare coverage and an aging population, Medicare reimbursements have declined, Yi told session attendees. This combination is what sparked his effort to explore how financially successful radiologists make the best of Medicare reimbursements.
"In my experiences in medical school and orthopedic surgery residency prior to my career change to radiology, I saw many different practice models among surgeons, which resulted in vastly different levels of reimbursement," he told AuntMinnie.com. "I had a hunch that there would be very savvy radiologists who would be reimbursed for their practice at levels much higher than the average, just as there are surgeons who do the same."
Yi and colleagues used Medicare's Provider Utilization and Payment database to identify the 50 diagnostic radiologists who received the most reimbursements in 2014. The group tracked total reimbursements, the total number of patients treated, and the distribution of reimbursements among the types of services provided.
The top 50 Medicare-reimbursed radiologists in 2014 were each paid an average of $1.9 million for treating an average of 2,524 patients. The average payment per patient was $3,018.
Reimbursements were prompted by the following service types:
- Procedures: 40%
- Imaging tests: 31%
- Radiation oncology procedures: 10%
- Other services: 19%
Yi's group also noticed that 80% of these top-paid radiologists focused their practices on one type of service (for example, imaging studies), while the remaining 20% had a mix of imaging studies and procedures.
The 50 radiologists were fairly evenly distributed by geographical area, with 28% in the Northeast, 30% in the West, and 35% in the South, although there were only 6% in the Midwest.
Session moderator Dr. David C. Levin of Thomas Jefferson University asked Yi how these radiologists could bill Medicare for so much, especially if Medicare constitutes only a quarter to a third of the average radiologist's practice mix.
"If we estimate Medicare reimbursements to be a quarter of a radiologist's income, are these top 50 radiologists billing $8 million a year?" Levin said. "There's no way one person could be that efficient."
They could be billing on behalf of a whole group, Yi replied.
"Although if they are, it prompts the question of why they're doing that," he said.
Unusual billing practices aside, it seems that focusing one's practice helps maximize Medicare payments, Yi told AuntMinnie.com.
"One way of doing this is to practice within a specific specialty so that interpreting studies or performing procedures will be second nature," he said. "By specializing in one area -- say, musculoskeletal imaging or neuroradiology -- a radiologist could reasonably expect to be faster than if he or she were interpreting studies from multiple specialties."
Yi also suggested that radiologists educate themselves on how studies and procedures are billed and ensure that they have all of the documentation needed for maximum reimbursement.
"Making sure that all eligible procedure codes are used is important," he told AuntMinnie.com. "If you performed a service, make sure you let the billers know."