Vijay Madan Rao MD, Presenter: Nothing to Disclose

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

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

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

The DRA cut technical component payments for private office MRI and CT. While radiologists have no control over referrals, nonradiologist physicians (NRPs) can potentially make up for revenue shortfalls by self-referring more exams. We therefore studied private office volume and payment trends in recent years, with special emphasis on 2007, the first year after the DRA took effect.

The nationwide Medicare Part B databases for 2002-2007 were studied. All MRI and CT codes were selected. Using Medicare physician specialty and place-of-service codes, exams performed in private offices by radiologists were identified and compared with those by NRPs. Global and technical component claims were tabulated to allow us to determine equipment ownership. We report the pre-DRA compound annual growth rates for 2002-2006 and the post-DRA one-year rates.

For MRI: radiologists’ private office volume increased 8.4% yearly from ’02-’06, then dropped 2.0% in ’07. NRPs’ office volume increased 24.7% yearly, then increased another 7.6% in ’07. Office MRI payments to radiologists increased 11.2% yearly, then dropped 30.1% in ’07. NRPs’ office MRI payments increased 25.7% yearly, then dropped 23.5% in ’07. For CT: radiologists’ private office volume increased 11.2% yearly, then increased another 2.9% in ’07. NRPs’ office volume increased 31.8% yearly, then increased another 18.1% in ’07. Office CT payments to radiologists increased 13.3% yearly, then dropped 5.2% in ’07. NRPs’ office CT payments increased 35.0% yearly, then increased another 8.3% in ’07.

After the DRA took effect, office MRI volume dropped among radiologists but increased among NRPs. MRI payments dropped to both, but the % decrease to radiologists was greater. Office CT volume increased slightly among radiologists but increased much more among NRPs on a % basis. CT payments to radiologists dropped, but they increased to NRPs. These results are consistent with the idea that NRPs are able to ameliorate the effects of the DRA by increasing self-referral. These trends are of concern and should be scrutinized in future years.

Not applicable.

Rao, V, Levin, D, Parker, L, Frangos, A, Trends in Utilization and Payments for MRI and CT By Radiologists and Nonradiologist Physicians in Private Offices before and after the Deficit Reduction Act (DRA).  Radiological Society of North America 2009 Scientific Assembly and Annual Meeting, November 29 - December 4, 2009 ,Chicago IL. http://archive.rsna.org/2009/8002778.html