Charles M. Intenzo MD, Presenter: Nothing to Disclose

Sung M. Kim MD, Abstract Co-Author: Nothing to Disclose

David Capuzzi MD, Abstract Co-Author: Nothing to Disclose

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

Both radiologists (RAD) and nonradiologists (NONRAD) perform therapeutic radioiodine (RAI) procedures for hyperthyroidism and thyroid cancer throughout the USA, a potential "turf" issue.  RAD include primarily nuclear medicine physicians, while NONRAD include primarily endocrinologists.  The latter group benefitted in 2000 when the Nuclear Regulatory Commission (NRC) issued new rulings, 10 CFR Parts 35.932 and 35.934, which reduced the number of training hours for therapeutic RAI procedures to 80, thereby easing MRC licensure requirements for endocrinologists.  Our purpose was to determine the % of RAI procedures performed by both RAD and NONRAD on Medicare patients, using the most recent national Medicare database available (2007), and compare them to the % difference of RAI procedures performed at the time of the earliest available Medicare database (1996).

All relevant CP-4 codes from the national Medicare Part B database for 1996 through 2007 were selected for hyperthyroidism, thyroid cancer ablation, and metastatic thyroid cancer ablation.  From this data, the procedure volumes for RAD and NONRAD were tabulated. 

In 1996, a total of 13,273 RAI procedures were performed on Medicare patients, of which RAD performed 9,715 (73%) and NONRAD performed 2,938 (22%).  The remaining 5% were performed by physicians in multispecialty groups and independent daignostic facilities (MS/IDF) who are either RAD or NONRAD.  In 2007, a total of 13,004 RAI procedures were performed on Medicare patients; 9,002 (69%) by RAD and 3,976 (30%) by NONRAD (less than 1% were done by MS/IDF).

(1)  From 1996 to 2007, the volume of RAI treatments on Medicare patients slightly decreased by 2%.  (2)  In 1996, RAD performed 73% of all treatments; this decreased by 7.3% by 2007. (3)  In 1996, NONRAD performed 22% of all treatments; this increased by 36.3% by 2007.

Nonradiologists are gaining market share in RAI treatments of Medicare patients, arguably on account of NRC rulings. 

Intenzo, C, Kim, S, Capuzzi, D, Frangos, A, Significant Changes and Trends in the Provider Distribution of Therapeutic Radioiodine Procedures Performed by Radiologists and Non-radiologists in the USA:  Results of a Multiyear Analysis.  Radiological Society of North America 2009 Scientific Assembly and Annual Meeting, November 29 - December 4, 2009 ,Chicago IL. http://archive.rsna.org/2009/8009068.html