There's increasing evidence that Medicare spending on medical imaging is slowing across the U.S. But spending has dropped at different levels in different states, indicating that future spending cuts should be more tailored, according to a study presented at the American College of Radiology's ACR 2015 meeting in Washington, DC.
Dr. Andrew Rosenkrantz from NYU Langone.
The group found that after 2006, imaging spending decreased in almost all states. Why? Multiple reasons, Rosenkrantz told AuntMinnie.com.
"There are a broad mix of factors that have contributed to the decrease in Medicare's imaging spending, from policy changes, the Deficit Reduction Act of 2005, the Multiple Procedure Payment Reduction, and the expansion of bundled codes to external factors such as the recession, radiation concerns, and increased penetration in the market of radiology business management groups," he said.
Nationally, Medicare Part B imaging spending per beneficiary increased on average by about 7.8% annually between 2004 and its peak in 2006. Spending then decreased by about 4.4% annually between 2006 and 2012, the researchers found.
| National Medicare spending on imaging per beneficiary | ||
| 2004 | 2006 | 2012 |
| $350.54 | $405.41 | $298.63 |
Rosenkrantz and colleagues also reported which states had the highest and lowest spending in the first and last years of the study time frame.
| States with highest Medicare imaging spending per beneficiary | |||
| 2004 | 2012 | ||
| Florida | $450.99 | Florida | $367.25 |
| Nevada | $432.95 | New York | $355.67 |
| New York | $415.52 | Nevada | $350.01 |
| Delaware | $378.33 | California | $283.37 |
| Texas | $351.42 | Maryland | $277.64 |
| States with lowest Medicare imaging spending per beneficiary | |||
| 2004 | 2012 | ||
| Vermont | $112.58 | Ohio | $67.08 |
| New Hampshire | $121.98 | Vermont | $72.78 |
| North Dakota | $141.86 | Idaho | $110.66 |
| Oregon | $147.56 | Kansas | $110.97 |
| Wyoming | $149.73 | North Carolina | $115.53 |
Although geographic variation was high across the study period, the states did show a consistent temporal trend, according the researchers. Spending peaked in 49 of the 50 states and Washington, DC, in either 2005 (six states) or 2006 (43 states); thereafter, there was an average annual decrease in spending in these 49 states of 5.1%. Only Maryland and Oregon showed an opposite trend.
"Both Maryland and Oregon actually showed increased per beneficiary imaging spending, perhaps because both of these states have put state-level Medicare reform in place," Rosenkrantz told AuntMinnie.com. "Their systems may shield them from the impact of federal policy on imaging spending."
The research suggests that as policymakers consider how to curb healthcare costs, it's better to take a micro rather than a macro view, according to Rosenkrantz: In states with more pronounced reductions in imaging spending, further cuts could negatively affect clinical outcomes -- or even end up increasing costs from missed or delayed diagnoses.
"We found that there was an abrupt, sustained decrease in imaging spending in almost every state in 2005 and 2006, and that geographic variations were quite marked," he said. "This tells us that any policy initiative needs to look at these variations and take into account state-by-state factors in order to be effective."
