Bhavik Patel MD, Presenter: Nothing to Disclose

David C. Levin MD, Abstract Co-Author: Consultant, HealthHelp, LLC Board of Directors, Outpatient Imaging Affiliates, LLC

Laurence Parker PhD, Abstract Co-Author: Nothing to Disclose

Vijay Madan Rao MD, Abstract Co-Author: Nothing to Disclose

To study recent outpatient imaging trends in private offices and hospital outpatient departments (HOPDs) to determine if any shifting has occurred between the two. Concern has been expressed that reduced reimbursements and other factors might lead to closure of offices and a shift to higher cost HOPDs.

The nationwide Medicare Physician/Supplier Procedure Summary Master Files for 2000-2012 were studied. All CPT codes for MRI, echocardiography, nuclear medicine, ultrasound, and CT were selected and procedure utilization rates per 1,000 Medicare beneficiaries were determined for each year. Medicare location codes identified the settings where the scans were performed.

Total utilization rates per 1,000 of all these exams in private offices grew rapidly from 415 in 2000 to 874 in the peak year of 2008 (+111%). The rate then declined sharply to 503 in 2011 (-42%), primarily as a result of code bundling in echocardiography in 2009, nuclear cardiac exams in 2010, and CT abdomen/pelvis in 2011. No further bundling occurred in 2012 but there was continued decline from 503 to 475 that year. In HOPDs, the total rate rose from 391 in 2000 to 523 in 2008 (+34%), followed by a bundling-related decline to 418 (-20%) in 2011. But in 2012, in contrast to what happened in offices, the HOPD rate increased from 418 to 426. The ratio of private office to HOPD advanced imaging was 1.67 in 2008, declining to 1.11 in 2012. Similar shifts away from offices and into HOPDs were quite apparent in MRI, echocardiography, and nuclear medicine, and present but less apparent in ultrasound and CT. The office-to-HOPD ratio in 2008 and 2012 were as follows in the different modalities: MRI 1.12 and 0.93; echocardiography 3.62 and 1.71; nuclear medicine 2.59 and 1.00; ultrasound 1.82 and 1.74; and CT 0.54 and 0.47.

In recent years, there has been a shift in utilization from private offices into HOPDs in MRI, echocardiography, nuclear medicine, and to a lesser extent, ultrasound and CT. This could portend a loss of access for patients to advanced imaging, and an increase in costs due to the higher reimbursements paid to HOPDs.

Not applicable.

Patel, B, Levin, D, Parker, L, Rao, V, The Shift in Outpatient Advanced Imaging from Private Offices to Hospital Facilities.  Radiological Society of North America 2014 Scientific Assembly and Annual Meeting, - ,Chicago IL. http://archive.rsna.org/2014/14015283.html