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Prevalence of "One-Off Events" in Radiology: Implications for Radiology in Episode-Based Alternative Payment Models.

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A significant portion of diagnostic imaging studies are nonepisodic, or one-off events, challenging value-based reimbursement models. This highlights a gap in current payment frameworks for radiologists' non-patient-facing work.

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Area of Science:

  • Radiology
  • Health Economics
  • Medical Informatics

Background:

  • Value-based reimbursement models are increasingly adopted, but their applicability to non-patient-facing specialists like radiologists is unclear.
  • Diagnostic radiology often involves nonepisodic care, defined as one-off events, which may not fit episodic measurement tools.

Purpose of the Study:

  • To determine the prevalence of nonepisodic, or one-off, diagnostic imaging events.
  • To assess how this prevalence varies by body region and place of service.

Main Methods:

  • A retrospective study analyzed diagnostic imaging from a large commercial payer database (2015-2019).
  • One-off events were defined as imaging studies with no further studies in the same body region within 12 months, with an alternative stringent definition used.
  • Prevalence was computed overall, by body region, and by place of service.

Main Results:

  • One-off events constituted 33.2%-45.8% of diagnostic imaging studies.
  • Prevalence varied significantly by body region, with cardiac imaging being highest (80.9%-87.7%) and chest imaging lowest (26.8%-35.2%).
  • The proportion of one-off events was lowest in inpatient (12.9%-29.1%) and long-term care (18.6%-30%) settings.

Conclusions:

  • A substantial proportion of diagnostic radiology workload consists of one-off events.
  • Current episodic measurement tools and value-based payment models may not adequately encompass radiologists' work.
  • Further consideration is needed to adapt reimbursement strategies for nonepisodic care in radiology.