It's enough to make some radiologists feel like they're sitting under the sword of Damocles. On the one hand, innovations in technology and modalities have increased productivity, lowered costs, and enhanced diagnoses. On the other, radiologists who increase their use of these devices can raise suspicions of abuse in the Office of Inspector General (OIG) of the U.S. Department of Health and Human Services.
"The OIG has recently expressed concern about the 11% annual growth in the utilization of MR and the appropriateness of that utilization," said Dr. David Levin during a presentation at the 2001 RSNA meeting in Chicago. Levin and a team of researchers from Thomas Jefferson University Hospital in Philadelphia recently examined MR use in the U.S. Medicare Part B databases for 1993, 1996, and 1999.
The team analyzed the data in an effort to quantify how rapidly MR utilization has increased in recent years, and to see if there were differences in utilization growth depending upon whether the modality was used by radiologists or nonradiologists.
The researchers reviewed category 4 current procedure terminology (CPT-4) codes for MR, and divided the codes into 5 categories -- cranial, spinal, musculoskeletal (MSK), body, and cardiac. In all, 465 CPT-4 codes were reviewed. They then classified providers, using the Medicare specialty codes, as either radiologists or nonradiologists and determined the utilization between both groups.
Next, the data were calculated to assess trends, based on utilization rates per 1,000 Medicare beneficiaries per year. "Our data set include Medicare fee-for-service patients, but did not include HMO Medicare patients, who represent approximately 15% of the total," Levin said.
The group found that MRI utilization rose 66% between 1993 and 1999, from 50.1 to 82.9 per 1,000 Medicare beneficiaries. By further discriminating the data based on body parts, they found that MR use increased by 44% for cranial studies, 75% for spinal studies, 33% for cardiac exams, 76% for body studies, and a whopping 134% for MSK exams during the same time period.
The database showed a concurrent rise in the number of MR exams performed by radiologists, Levin said. The specialty was performing 45.5 MR studies per 1,000 beneficiaries in 1993 and 72.9 of the procedures in 1999, a 60% increase. However, the number of other physicians conducting MR exams also rose. At the beginning of the sampled time frame, they were performing 2.2 MR studies per 1,000 beneficiaries -- but by 1999, the number of exams had increased 221%, to 7 per 1,000.
Although the data showed that the most rapid MR utilization growth occurred in MSK exams, cranial and spinal MR still accounted for 80% of overall utilization, while body and cardiac studies together accounted for only 5% of total use. Levin speculated that self-referral by the nonradiologists who performed 9% of the total MR exams might account for their utilization rate increases over the six-year period.
The group surmised that the growth in MR utilization is due to a combination of many factors. For one thing, MR was not a mature technology and had only been in common use for about six years in 1993. In the intervening six years of the reviewed data, applications, protocols, price points, physician familiarity, and technological advances all served to increase its use, Levin said.
By Jonathan S. BatchelorAuntMinnie.com staff writer
December 26, 2001
Related Reading
Ongoing study finds differing trends among clinicians on requests for advanced imaging, June 9, 2000
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