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Characteristics of COVID-19 Community Practice Declines in Noninvasive Diagnostic Imaging Professional Work
Richard Duszak1, Jeff Maze2, Candice Sessa3
1Professor and Vice Chair of Radiology, Department of Radiology and Imaging Sciences, Emory University School of Medicine, and Emory Healthcare, Atlanta, Georgia.
Insights
The COVID-19 pandemic caused significant declines in diagnostic imaging work, with mammography experiencing the most substantial impact. These findings offer insights for planning future pandemic responses in radiology practices.
Area of Science:
- Radiology and Medical Imaging
- Public Health and Epidemiology
- Healthcare Management
Background:
- The widespread impact of the coronavirus disease 2019 (COVID-19) on healthcare services, including diagnostic imaging, has raised concerns about operational and financial consequences for radiology practices.
- The extent of these declines in professional work within community radiology settings remains largely uncharacterized.
Purpose of the Study:
- To quantify and characterize the declines in noninvasive diagnostic imaging professional work within U.S. community radiology practices during the COVID-19 pandemic.
- To identify specific imaging modalities and body regions most affected by these work declines.
Main Methods:
- Utilized imaging metadata from nine U.S. community radiology practices spanning January 2019 to May 2020.
- Mapped work relative value unit (wRVU)-weighted diagnostic imaging service codes to modality and body region.
- Analyzed weekly wRVU changes in 2020 compared to 2019, stratified by modality, body region, and service site, with practice share chi-squared testing.
Main Results:
- Aggregate weekly wRVUs decreased by 52% from February to April 2020, with the greatest outpatient declines at -66%.
- Computed Tomography (CT) and radiography/fluoroscopy showed the largest percentage declines in wRVUs (31% and 30%, respectively).
- Mammography experienced the most significant decline across modality-region groups (-92%), alongside substantial reductions in abdomen/pelvis and breast imaging.
Conclusions:
- COVID-19 significantly reduced diagnostic imaging work across community practices, with remarkably similar trends observed nationwide.
- Mammography was disproportionately affected, highlighting the need for targeted support and planning.
- Understanding these decline patterns is crucial for future pandemic preparedness, impacting practice workflows, finances, patient access, and payment policies.
Purpose:
The operational and financial impact of the widespread coronavirus disease 2019 (COVID-19) curtailment of imaging services on radiology practices is unknown. We aimed to characterize recent COVID-19-related community practice noninvasive diagnostic imaging professional work declines.
Methods:
Using imaging metadata from nine community radiology practices across the United States between January 2019 and May 2020, we mapped work relative value unit (wRVU)-weighted stand-alone noninvasive diagnostic imaging service codes to both modality and body region. Weekly 2020 versus 2019 wRVU changes were analyzed by modality, body region, and site of service. Practice share χ2 testing was performed.
Results:
Aggregate weekly wRVUs ranged from a high of 120,450 (February 2020) to a low of 55,188 (April 2020). During that -52% wRVU nadir, outpatient declines were greatest (-66%). All practices followed similar aggregate trends in the distribution of wRVUs between each 2020 versus 2019 week (P = .96-.98). As a percentage of total all-practice wRVUs, declines in CT (20,046 of 63,992; 31%) and radiography and fluoroscopy (19,196; 30%) were greatest. By body region, declines in abdomen and pelvis (16,203; 25%) and breast (12,032; 19%) imaging were greatest. Mammography (-17%) and abdominal and pelvic CT (-14%) accounted for the largest shares of total all-practice wRVU reductions. Across modality-region groups, declines were far greatest for mammography (-92%).
Conclusions:
Substantial COVID-19-related diagnostic imaging work declines were similar across community practices and disproportionately impacted mammography. Decline patterns could facilitate pandemic second wave planning. Overall implications for practice workflows, practice finances, patient access, and payment policy are manifold.
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