There's at least one bright spot in the traditional gloomy assessment that non-radiologists are winning the imaging turf wars. According to five years of Medicare data, radiologists are performing more emergency room x-rays, and participation by other emergency room physicians is falling.
In a presentation at the 2000 RSNA meeting, Dr. Vijay Rao and colleagues from Thomas Jefferson University Hospital in Philadelphia looked at changing practice patterns in U.S. emergency rooms between 1993 and 1998 using nationwide HCFA files, which include both Medicare and fee-for-service (FFS) subscribers.
"The coverage was about 33.6 million subscribers in 1993, which actually decreased to 31.9 million in 1998 because of an increasing number of patients shifting to Medicare managed care plans," Rao said.
There were a total of 4.4 million claims for emergency room radiographic studies in 1993, rising to 6.3 million in 1998. The claims were broken down by procedure (CPT) codes into five categories, including chest (five codes), abdomen (four codes) head and neck (24 codes), upper and lower extremities (34 codes), and spine and pelvis (26 codes).
Claims were then divided according to the specialty of the providing physician: radiologist, emergency medicine physician, or "other." Multispecialty group claims (about 5% of the total), were excluded since the specialty of the providing physician could not be determined for these studies, Rao said.
According to the results, emergency medicine physicians performed significantly fewer radiographic procedures overall in 1998 than in 1993, Rao said. In 1993, emergency room physicians performed 4.2% of 4.4 million radiographic studies, while in 1998 ER physicians performed 2.1% of 6.4 million studies.
"In 1993 the vast majority of (chest) procedures were done by radiologists, 93%, and emergency room physicians performed about 4.7% of these studies," Rao said. "Whereas in 1998, the level of participation by radiologists increased to 96.4%, and participation by emergency medicine physicians actually declined, from 4.7% to 2.3%, and there was minimal participation by the rest."
The decline was seen across the board. In abdominal studies, which saw a 49% increase in total studies over five years (456,650 in 1993 to 680,971 in 1998), radiologists performed 93% of the procedures in 1993 and 96.6% of the procedures in 1998. Over the same period, participation by emergency department physicians declined from 4.3% to 2.2%.
Similarly, in head and neck studies (totaling 148,603 in 1993 vs. 150,738 in 1998) ED physician participation declined from 3.4% in 1993 to just 1.4% in 1998. In spine and pelvis studies, ED physicians performed 3.2% of 468,935 exams in 1993, compared with 1.7% of 694,420 exams in 1998. And ED physicians in 1993 performed 3.6% of 1.03 million extremity studies, compared with just 1.7% of 1.53 million procedures in 1998.
In conclusion, Rao said the number of emergency department studies increased substantially between 1993 and 1998, while utilization was up 30% over the five-year period. Radiologists performed 96.7% of radiographic studies in 1998, compared with 93.9% in 1993. Claims submitted by "other" physicians remain insignificant: 1.9% of 1993 claims, and just 1.2% in 1998, she said.
"One of the things we can speculate [is] that it's perhaps related to broader night coverage of emergency rooms by radiologists nationwide," Rao said. "That might be one of the reasons why we're seeing this trend."
Emergency radiologists can celebrate their gains in San Francisco this year, where the American Society of Emergency Radiology will be holding its annual conference from March 14-17. Visit the society's Web site for more information about the meeting.
By Eric BarnesAuntMinnie.com staff writer
March 1, 2001
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