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Recent reimbursement changes and their effect on hospital and private office use of myocardial perfusion imaging
David C Levin1, Laurence Parker, Charles M Intenzo
1Center for Research on Utilization of Imaging Services, Department of Radiology, Thomas Jefferson University Hospital , Philadelphia, Pennsylvania 19107, USA. david.levin@jeffersonhospital.org
Purpose:
The aims of this study were to examine recent trends in the utilization of radionuclide myocardial perfusion imaging (MPI) and to reflect on their causes and their implications for radiologists.
Methods:
Nationwide Medicare Part B databases for 2000 through 2010 were used. Codes for primary MPI studies (including PET) were selected. Medicare specialty codes were used to identify MPI examinations done by radiologists, cardiologists, and other physicians. Place-of-service codes were used to identify examinations performed in offices versus hospital settings. Utilization rates per 1,000 fee-for-service beneficiaries were calculated. Trends were assessed by place of service and specialty.
Results:
The overall MPI utilization rate rose from 2000 through 2004, followed by a period of stabilization from 2005 to 2008. A peak of 88.0 per 1,000 was reached in 2006. In 2009 and 2010, a decline occurred, with the rate dropping by 13% to 76.9. In private offices, cardiologists' utilization grew rapidly from 2000 through 2006, but growth stopped thereafter. Their rate peaked in 2008 at 50.6 but dropped to 44.4 by 2010 (-12%). Radiologists' role in office MPI was minimal. In hospital settings, radiologists predominated in 2000. Their rate remained stable through 2004 but thereafter began to decline steadily, dropping by 35% by 2010. Cardiologists' hospital-based utilization rate rose gradually, then flattened, but began to rise in 2009 and 2010. By 2010, cardiologists performed more hospital MPI examinations than radiologists.
Conclusions:
Radiologists' initially predominant role in hospital-based MPI has eroded recently, while that of cardiologists has strengthened. This seems related to a shift among cardiologists away from office practice and into hospital affiliations.
Insights
Cardiologists now perform more hospital myocardial perfusion imaging (MPI) than radiologists, reflecting a shift in practice settings. This trend impacts the roles of physicians in cardiac diagnostics.
Area of Science:
- Cardiovascular Imaging
- Radiology
- Health Services Research
Background:
- Myocardial perfusion imaging (MPI) is a key diagnostic tool in cardiology.
- Understanding trends in MPI utilization is crucial for healthcare providers and resource allocation.
- Recent shifts in practice patterns may affect the roles of different medical specialties.
Purpose of the Study:
- To analyze recent trends in radionuclide myocardial perfusion imaging (MPI) utilization.
- To investigate the causes behind observed changes in MPI use.
- To determine the implications of these trends for radiologists.
Main Methods:
- Utilized nationwide Medicare Part B databases from 2000-2010.
- Identified MPI studies (including PET) using specific billing codes.
- Analyzed utilization rates by physician specialty (radiologists, cardiologists) and place of service (office vs. hospital).
Main Results:
- Overall MPI utilization peaked in 2006, then declined by 13% by 2010.
- Cardiologists' office-based MPI utilization grew until 2006, then decreased.
- Radiologists' hospital-based MPI share significantly declined by 35%, with cardiologists performing more hospital MPI by 2010.
Conclusions:
- The predominant role of radiologists in hospital MPI has diminished.
- Cardiologists' involvement in hospital MPI has increased, surpassing radiologists by 2010.
- These shifts are likely associated with cardiologists moving from office-based to hospital-affiliated practices.
