Santosh Kumar Selvarajan 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

Policymakers and payers have been concerned with the rapid growth in imaging utilization. But recent studies have shown that outpatient advanced imaging use has leveled off and begun to drop. Our purpose was to see if this trend has manifested itself in Emergency Departments (EDs).

The nationwide Medicare Part B Physician/Supplier Procedure Summary Master Files for 2002-2012 were the data source. CPT codes for plain radiography (XR), noncardiac ultrasound (US), CT, MRI, and nuclear medicine (NM) were aggregated by modality. Medicare’s place-of-service codes were used to identify those exams done during ED visits, and its specialty codes were used to determine which specialties did the interpretations. Utilization rates per 1000 Medicare beneficiaries were calculated. Trends from 2002 to 2012 were assessed.

Between 2002 and 2012, the ED utilization rate per 1000 of XR increased from 248.8 to 320.0 (+29%). Noncardiac US increased from 9.5 to 21.0 (+121%). CT increased from 57.2 to 147.9 (+159%). MRI increased from 1.4 to 5.1 (+264%). Only NM showed a slight numerical decline, from 2.8 to 2.1 (-25%), but this was largely due to code bundling that occurred in myocardial perfusion imaging in 2010. In each of the first 4 modalities, growth was steady and progressive with no evidence of slowing. Raw numbers per 1000 beneficiaries of accrued new exams between 2002 and 2012 were: XR 71.3, US 11.5, CT 90.7, MRI 3.7, NM -0.7. Radiologists’ share of the interpretations in 2012 were: XR 97%, US 89%, CT 99%, MRI 99%, NM 93%.

In contradistinction to the trends among outpatients, utilization rates of imaging in EDs grew continuously and substantially from 2002 to 2012. The largest numerical increases were seen in CT and XR. Radiologists strongly predominate in interpreting in all modalities. The degree of growth is of some concern and suggests that more attention needs to be directed to imaging appropriateness criteria in EDs.

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Selvarajan, S, Levin, D, Parker, L, Rao, V, Imaging Utilization Trends in Emergency Departments in the Medicare Population.  Radiological Society of North America 2014 Scientific Assembly and Annual Meeting, - ,Chicago IL. http://archive.rsna.org/2014/14003464.html