CHICAGO - The sharp growth in imaging services conducted by nonradiologists in the U.S. over the past 10 years has been a focus of increased scrutiny by both payors and policymakers. Although turf in-roads have been made on many high-end imaging procedures traditionally performed by radiologists, MR imaging is still the purview of the specialty, according to data from the Center for Research on Utilization of Imaging Services (CRUIS) at Thomas Jefferson University in Philadelphia.
"According to the Blue Cross Blue Shield Association Medical Cost Reference Guide, projected growth in the volume of high-end imaging procedures, such as CT and MRI, is expected to be about 67% between 2000 and 2008," said Dr. Vijay Rao, a radiologist and member of the research team at Thomas Jefferson University, during a presentation at the 2005 RSNA conference on Tuesday afternoon.
Her research group used the U.S. Centers for Medicare and Medicaid Services (CMS) Medicare Part B Master Summary datasets from 2001 to 2003 to identify all CPT-4 codes for MR imaging, as well as the procedure volume within each code, she said. Their aim was to determine the growth of nonradiologist MR imaging in the U.S. during that time period.
Overall, CMS has 108 unique Medicare provider specialty codes, one of which appears on every claim. The scientists utilized these codes to determine the specialty of the physician providers, Rao said.
The researchers grouped the medical provider specialties into 23 categories to simplify data analysis. They then tabulated procedure volume for each specialty category and the changes in that volume for each of the categories from 2001 to 2003.
Studies performed by multispecialty groups and independent diagnostic testing facilities (IDTFs), which were 8% of the total surveyed, were excluded because the provider specialty could not be determined in that subset, Rao noted.
The data showed that the nonradiologist specialties with the highest Medicare MRI volume were neurologists, with about 71,000 procedures in 2003, a 20% utilization uptick for the specialty since 2001. Orthopedic surgeons are taking a bigger bite of the MR imaging pie, performing 51,162 procedures in 2003, a 79% utilization surge.
Primary care physicians have also gotten into the MR field, performing 34,230 procedures in 2003, a 62% upswing in utilization. Radiation oncologists have added MR services to their armamentarium, performing 26,042 exams in 2003, a 90% utilization growth rate. Neurosurgeons have also hopped onto the MR bandwagon, billing CMS in 2003 for 10,759 procedures, a 41% increase since 2001. According to the researchers, no other specialty performed more than 10,000 examinations in 2003.
According to the Medicare database, the number of MR exams by all nonradiologists in 2003 was 227,334, a 54% utilization increase from their self-use of the modality in 2001. Rao noted that radiologists performed more than 4.5 million MR studies in 2003, a 38% growth rate from 2001. Radiologists' share of all MR procedure volume in 2003 was 95%, she said.
"Radiologists strongly dominated the market in MR imaging in 2003," Rao said.
However, she observed that utilization by nonradiologists is growing at a faster rate than that by radiologists. In addition, she cited recent anecdotal reports of expansion by nonradiologists into in-office MR imaging services, which may further erode radiologists' share of procedure volume.
"This is a trend we have to watch carefully to see if self-referral becomes an issue in this area also," Rao noted.
AuntMinnie.com staff writerDecember 1, 2005
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