While the 2005 Deficit Reduction Act (DRA) did reduce the growth rate of in-office, noninvasive musculoskeletal imaging performed by nonradiologists, the legislation failed to stifle the practice, according to a new study published in the July issue of Radiology.
In a study of Medicare files from 2004, 2006, and 2008, researchers from Yale University School of Medicine found that despite the slowdown in this type of imaging -- i.e., self-referral -- after the DRA was implemented, the amount of in-office, noninvasive musculoskeletal imaging performed by nonradiologists was still greater than that performed by radiologists (Radiology, July 2012, Vol. 264:1, pp. 146-153).
Lead author Dr. Scott Kennedy and Dr. Howard Forman used Medicare Part B Physician/Supplier Procedure Summary files for 2004, 2006, and 2008 to measure how the DRA's payment reductions affected the utilization growth rate between the pre-DRA (2004 to 2006) and post-DRA (2006 and 2008) periods.
The authors found that when each of 111 noninvasive musculoskeletal imaging procedures were considered separately, in the office setting, the decrease of per-capita imaging was greater the higher the percentage payment reduction the DRA imposed -- and this was true for both nonradiologists and radiologists. However, in the outpatient hospital setting, there was no pattern between increase or decrease of imaging use and the size of payment reductions.
Kennedy and Forman also found that when all of the 111 procedures were considered together, imaging growth was slower after the DRA went into effect than before, but there was still positive growth, both for nonradiologists and radiologists, rather than a decline in utilization.
And although aggregate growth slowdown was three or four times as large for nonradiographic imaging as for all imaging (again, true for both nonradiologists and radiologists), nonradiographic imaging continued to show a positive growth rate, particularly among nonradiologists. In fact, MR imaging by nonradiologists in the office setting continued to grow almost three times as fast as MR imaging by radiologists in the office setting, according to Kennedy and Forman.
Trends in nonradiographic, noninvasive musculoskeletal imaging according to setting and physician category for Medicare beneficiaries, 2004 to 2008
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There's strong evidence that the high utilization associated with nonradiologists performing their own imaging is a consequence of financial incentives, according to the authors.
It seems likely, therefore, that nonradiologists would reduce the imaging they themselves do when the financial advantage is reduced by payment cuts, especially large cuts, Kennedy and Forman wrote. But imaging volumes by nonradiologists continued to grow, although more slowly than before the DRA was enacted.
It's important to keep an eye on self-referral, the authors concluded.
"As of 2008, self-referred imaging in the office setting was still growing, particularly for nonradiographic imaging," they wrote. "Given that self-referral engenders unnecessary costs and radiation exposure, further regulatory or administrative action against [the practice] seems warranted."
