Double Scan CT Rates: An Opportunity for Facility-Based Radiologist Measures in the Quality Payment Program

Area of Science:

• Radiology Quality Measurement
• Health Services Research
• Medical Economics

Background:

• The Medicare Access and CHIP Reauthorization Act (MACRA) allows the Centers for Medicare & Medicaid Services (CMS) to use hospital outpatient quality measures for radiologist evaluation.
• This shift offers an opportunity to assess radiologist performance using metrics that reflect facility-based practice patterns.

Purpose of the Study:

• To investigate radiologist characteristics associated with variations in performance for abdomen and chest CT "double scan" rates.
• To explore the utility of these measures for evaluating radiologist performance under MACRA.

Main Methods:

• Utilized 2014 Medicare Physician and Other Supplier data for abdomen and chest CT examinations in a facility setting.
• Calculated individual radiologist "double scan" rates and analyzed associations with radiologist characteristics using multivariable regression and cross-validation.

Main Results:

• Average "double scan" rates were 5.9% for abdomen CT and 1.0% for chest CT.
• Abdomen CT rates varied significantly by geography, practice size, and specialty (e.g., nuclear medicine physicians had higher rates).
• Intraclass correlation indicated moderate agreement within practices for both CT types, higher for chest CT.

Conclusions:

• Radiologist facility "double scan" rates demonstrate systematic variation linked to professional characteristics.
• These measures align Medicare's hospital and physician performance programs, incentivizing radiation dose and cost reduction.
• Abdomen CT "double scan" rates show greater variability, suggesting their utility in identifying disparities in radiologist performance.