Emergency physicians are ordering more x-ray and US but reading less

CHICAGO - An eight-year retrospective study of U.S. Medicare reimbursement data shows an increase in the volume of ultrasound and conventional radiographic studies in the emergency department and a decrease in the number of exams performed by emergency medicine physicians, according to radiology researchers from Thomas Jefferson University Hospital in Philadelphia.

“Emergency medicine physicians claim that their participation in noninvasive diagnostic imaging, particularly ultrasound and conventional x-ray, is substantial,” said Andrea Maitino, who presented the results of her and her colleagues’ research at the 2003 RSNA on Monday.

The group analyzed the Centers for Medicare and Medicaid Services (CMS) Part B Physician/Supplier Procedure Summary master files from 1993 to 2001. Maitino said all noninvasive diagnostic imaging CPT-4 codes from the 70,000 and 90,000 series representing ultrasound and conventional x-ray were examined to determine the total number of these exams that were performed.

“We excluded all supervision and interpretation codes in these ranges,” noted Maitino.

The total volume and overall share of each modality were calculated for each year for radiologists and emergency medicine physicians, as well as other non-radiologists and multispecialty groups using the Medicare provider and location of service codes.

The researchers found that the total volume of ultrasound examinations performed in the emergency department increased a little more than 164.5% from 1993 to 2001, from 134,533 to 355,889, respectively. The data also showed that emergency medicine physicians performed 0.6% of the exams in 1993 (760), and that percentage had decreased by half in 2001 to 0.3% of the exams (1,160).

Maitino reported that radiologists performed 64.9% (87,377) of the emergency department ultrasounds in 1993, and that this had grown to 72.3% (257,479) of the exams by 2001. Of interest, she noted, was the overall decrease in utilization of the modality by other non-radiologists from 30.1% (40,501) of the total in 1993 to 21.5% (76,649) in 2001. However, multispecialty groups saw a slight percentage increase in total share from 4.4% (5,895) in 1993 to 5.8% (20,601) of the total volume in 2001, she said.

When it came to performing conventional radiography, the Medicare data showed that emergency medicine physicians continued to shy away from noninvasive diagnostic imaging. Although the volume of film-screen x-ray increased by 57.3%, from 5.12 million exams in 1993 to 8.05 million in 2001, emergency medicine physicians’ performance of conventional x-ray deceased from 4.8% (243,705) in 1993 to 2.1% (167,968) of the total exams in 2001, according to the researchers.

Radiologists saw their share of the emergency department x-ray workload increase from 89% (4.6 million exams) in 1993 to 92.8% (7.5 million conventional radiographs) by 2001. Maitino observed that the data showed other non-radiologists and multispecialty groups also participating in the trend away from reading film-screen radiographs, with non-radiologist exams decreasing from 2.2% of the total in 1993 to 1.2% in 2001; and multispecialty groups dipping slightly from 4% in 1993 to 3.8% eight years later.

Although the data examined by the researchers represents a significant portion of the noninvasive diagnostic imaging in the U.S., Maitino cautioned that it represented only the fee-for-service Medicare population for the eight years surveyed by the group.

The facts of the Medicare data are clear, said Maitino.

“Emergency medicine physicians perform a very small percentage of all ultrasound and conventional radiography exams in the emergency department, with their share deceasing by nearly half between 1993 and 2001. Of the four specialty groups, these physicians were the only group whose share of ultrasound imaging decreased,” she noted.

By Jonathan S. Batchelor
AuntMinnie.com staff writer
December 2, 2003

Copyright © 2003 AuntMinnie.com

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