Association of Office-Visit Imaging Utilization with Radiologist Versus Ordering Provider Imaging Interpretation

To assess the association between imaging ordering rates after office-based evaluation and management (E&M) visits and the percentage of a practice's imaging studies interpreted by a radiologist versus the ordering provider.

CMS 5% Research Identifiable Files (2021-2023) were used to identify office-based E&M claims, patient and clinical characteristics, and associated imaging (CT, MR, nuclear medicine, ultrasound, radiography/fluoroscopy) within 30 days. Provider and practice characteristics were derived from the CMS Medicare Data on Provider Practice and Specialty. Multivariable logistic regression assessed the association between imaging after an E&M visit and the share of imaging interpreted by radiologists or ordering providers, controlling for provider, practice, patient, and clinical characteristics.

There were 24,243,642 E&M visits that met the selection criteria. Of these, 13.6% had imaging, and the ordering provider's self-interpretation rate was 33.2%. Practices with 100% versus 0% radiologist interpretation had lower adjusted odds ratios for 30-day imaging for all modalities except CT ranging from 0.59 (95% confidence interval [CI], 0.57-0.62) for ultrasound to 0.95 (95% CI, 0.90-0.99) for MR. Conversely, ordering providers with 100% versus 0% self-interpretation had higher odds ratios for visit-associated imaging, overall (2.88; 95% CI, 2.79-2.98) and for each modality ranging from 1.54 (95% CI, 1.42-1.66) for MR to 3.51 (95% CI, 3.37-3.65) for ultrasound. Odds varied by ordering provider subspecialty and patient diagnosis.

Imaging orders were more likely after visits to providers that always versus never self-interpret imaging, while visits to practices that refer a higher percentage of imaging to radiologists were less likely to result in imaging.