Temporal and Patient Variations Potentially Impacting New Payment Models.

Area of Science:

• Health Services Research
• Medical Economics
• Radiology Practice Management

Background:

• Medicare imaging utilization exhibits significant variability.
• Nongeographic patient and temporal factors are understudied drivers of this variation.

Purpose of the Study:

• To assess the influence of patient-specific and within-year temporal factors on Medicare imaging utilization.
• Identify key nongeographic determinants of imaging use in the Medicare population.

Main Methods:

• Analysis of national Medicare imaging events per 1,000 beneficiaries (2008-2014) using the CMS Chronic Conditions Data Warehouse.
• Stratification of imaging utilization by clinical (comorbidities) and sociodemographic (age, gender, ethnicity, dual eligibility, ESRD) factors.
• Descriptive summarization of quarterly imaging utilization data.

Main Results:

• Imaging utilization peaked in Q2 and was lowest in Q4 annually.
• Utilization increased substantially with higher patient comorbidity counts.
• Dual Medicaid eligibility and end-stage renal disease (ESRD) status were associated with higher utilization rates.
• Beneficiary age, gender, and ethnicity also demonstrated variations in imaging use.

Conclusions:

• Patient characteristics (comorbidities, dual eligibility, ESRD) and seasonal timing significantly impact Medicare imaging utilization.
• These findings are crucial for radiologists entering risk-bearing contracts, necessitating consideration of patient population features and contract timing.
• Understanding these variations is key to managing healthcare costs and optimizing imaging resource allocation.