Japanese universal health care insurance coverage system employs two-level additional "imaging management fee" system aside from technical fees: level-1) 700JPY/exam reimbursed for exams performed at facilities with fulltime radiologist(s): level-2) 1800JPY/exam reimbursed for those performed at facilities with fulltime radiologist(s) in charge of all imaging studies and writing timely reports. The purpose of the study was to evaluate if facilities reimbursed these imaging management fees are associated with increased exams based on financial incentives, or with reduced exam volume under the radiologist's strict control of appropriateness.
METHOD AND MATERIALSThis HIPAA-compliant, IRB-waived retrospective cohort study used unlinkable anonymized insurance claims data (2013-14) provided by the Japan Medical Data Center. Working-age (<65 years) subjects who underwent at least one outpatient MR imaging for benign lumbar/cervical conditions were included. The outcome was repeat outpatient MR exam without any surgical intervention/admission. A two-level hierarchical logistic regression models with patient-level (demographics, co-morbidities) and hospital-level covariates were developed to compare outcomes across three different facilities: (1) qualified to receive level-1 fee, (2) qualified to receive level-2 fee, and (3) not receiving imaging management fee.
RESULTSA total of 23688 subjects were included (16838 undergoing lumbar MR (mean age 38.8±15.4 years) and 6850 undergoing cervical MR (45.0±11.7 years)). During the 2-year period, 9.5% and 7.3% of the subjects underwent another MR exam for benign lumbar and cervical conditions, respectively. The hierarchical model showed higher odds of repeat exams at facilities that were reimbursed imaging management fees compared to other facilities: adjusted odds ratio of facilities (1) and (2) vs (3): 1.42 (95%CI:1.16-1.75) and 1.29 (1.11-1.49) for lumbar and 1.87 (1.37-2.55) and 1.46 (1.13-1.88) for cervical).
CONCLUSIONAt facilities which are qualified for additional reimbursement per exam, repeat MR exam for benign lumbar/cervical conditions in working-age subjects was more frequent compared to other facilities.
CLINICAL RELEVANCE/APPLICATIONAt facilities which are qualified for additional reimbursement per exam, repeat MR exam for benign lumbar/cervical conditions in working-age subjects was more frequent compared to other facilities.