Deficit reduction act: effects on utilization of noninvasive musculoskeletal imaging

To ascertain the effects of the payment reductions in the Deficit Reduction Act (DRA), which affected only in-office imaging, on the utilization of noninvasive musculoskeletal imaging.

This study of nonidentifiable aggregate data did not require institutional review board approval. Medicare Part B Physician/Supplier Procedure Summary Files for 2004, 2006, and 2008 were used. By using descriptive statistics and weighted linear regression, all 111 relevant procedure codes were evaluated to measure the effect of the DRA's payment reductions on change in utilization growth rate between the pre-DRA (2004-2006) and post-DRA (2006-2008) periods.

Overall, between the pre-DRA and post-DRA periods, the type of imaging studied demonstrated a 2% deceleration (reduction in per capita utilization growth rate) in the office and a 0.7% deceleration in the outpatient hospital setting. However, nonradiologist and radiologist utilization were both still growing, particularly for nonradiographic imaging. In the office, for both nonradiologists and radiologists, larger DRA payment reductions were associated with greater deceleration; deceleration was approximately 0.2% greater for each additional 1% of reimbursement reduction. There was no payment-reduction-size-related acceleration in the outpatient setting.

The growth rate of in-office noninvasive musculoskeletal imaging performed by nonradiologists and the growth rate of this type of imaging being referred to radiologists decreased in the period following the implementation of the DRA. Nonetheless, after the DRA, in-office nonradiographic noninvasive musculoskeletal imaging performed by nonradiologists was still growing much more rapidly than that performed by radiologists.