Laurence Parker PhD, Presenter: Nothing to Disclose

Andrea J Frangos MPH, Abstract Co-Author: Nothing to Disclose

David Carl Levin MD, Abstract Co-Author: Nothing to Disclose

Adam Eugene Flanders MD, Abstract Co-Author: Investigator, Hx Technologies, Inc, Phiiladelphia, PA Consultant, Geron Corporation, Denver, CO

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

Headache evaluation imaging is often cited as a possible area of overutilization of imaging services. This study describes current utilization of headache evaluation imaging in the Medicare population.

The data source for the study was the Center for Medicare and Medicaid Services (CMS) 2004 Limited Dataset (LDS), a 5% sample of all Medicare Part B claims. We extracted all allowed claims with a primary diagnosis of headache (13 diagnosis codes). Nine headache imaging categories (53 procedure codes) and a category comprising remaining imaging codes were created. Number of claims, headache patients, and allowed payments were tabulated. Prevalence rates, payments, percentages, utilization rates per/1000 headache patients, and confidence intervals were calculated. For volume and total payments, sample findings were multiplied by 20.

In the 5% sample, there were 176,543 paid claims for headache for 75,094 patients. Prevalence of headache was 39.8 (+-.3) per 1000. For the full Medicare population, this projects to 3.5 M claims, 1.5 M patients and total allowed payments of $401 M, of which $231 M (57.6%) are imaging costs. Imaging represented 25.1% of all claims. For the most utilized categories, utilization rates/1000 patients and the percent of imaging that these represented were: CT Head, 371, 62.9%; MRI Head, 103, 17.4%; and, X-ray, 36, 6.0%. No imaging was done for 51.7% of patients; one study for 40.7%; and more than one study for 7.7%. The maximum number of imaging studies for a single patient was 37, but less than 0.6% had more than 3.

For headache evaluation, the number of patients (1.5 M) and Medicare dollars paid ($400 M) are substantial. Nearly half of patients undergo an imaging procedure. Few patients undergo more than one imaging study. CT Head, MRI Head, and X-ray are the most common studies. While imaging represents about a quarter the number of headache procedures performed, it represents about three-fifths the cost. While the high proportion of imaging costs in headache evaluation may have attracted attention, there appears to be very little duplicative imaging.

Does not apply.

Parker, L, Frangos, A, Levin, D, Flanders, A, Rao, V, Utilization of Headache Evaluation Imaging in the Medicare Population: 2004.  Radiological Society of North America 2006 Scientific Assembly and Annual Meeting, November 26 - December 1, 2006 ,Chicago IL. http://archive.rsna.org/2006/4434422.html