Nonradiologists now eat up more of Medicare’s imaging pie | January 4 – Medicare payments for diagnostic imaging to nonradiologist physicians — especially cardiologists — have surpassed payments to radiologists, according to a new study published in the January issue of the Journal of the American College of Radiology.

David Levin, MD, and colleagues from Thomas Jefferson University in Philadelphia assessed Medicare Part B files covering all fee-for-service physician payments from 1998 to 2008. They selected all codes for discretionary noninvasive diagnostic imaging and found that the growth for fee-for-service payments to nonradiologists for these procedures was more rapid than growth for radiologists between 1998 and 2006.

“Radiologists have generally been considered to predominate in fee-for-service income from imaging,” Levin and colleagues wrote. “In the Medicare program, that may have been true in 1998, when they received 27% more than nonradiologist physicians. However, growth over the ensuing years was greater among nonradiologists, and by 2006, they received more [for imaging] than radiologists” (JACR, January 2011, Vol. 8, pp. 26-32).

Medicare payments for imaging to all physicians in all places of service grew from $4.9 billion in 1998 to a peak of $11.9 billion in 2006, an increase of 142%. In 2007, payments dropped sharply due to implementation of the Deficit Reduction Act (DRA) of 2005, before leveling out to $10.4 billion in 2008, according to the researchers.

Overall payments for radiologists increased by 107% between 1998 and 2006, while overall payments for nonradiologists increased by 166% during this time period. From 2006 to 2008, radiologists’ payments dropped by 13%, while nonradiologist physicians’ payments dropped by 11%.

Cardiologists represent the bulk of nonradiology physician recipients of Medicare payments for imaging services, Levin and colleagues wrote. Payments to cardiologists for imaging increased from $1 billion in 1998 to $2.7 billion in 2008, while payments to other nonradiologist physicians during this time frame increased from $1 billion to $2 billion.

The shift is due to more rapid growth in fee-for-service payments to nonradiologists between 1998 and 2006, combined with losses among radiologists after implementation of the DRA in 2007, according to the authors. Physician self-referral is also a cause: For imaging exams performed in their offices, nonradiologist physicians receive either a global or technical component payment, while most exams done by radiologists are performed in hospital settings, for which they receive only the lower, professional component reimbursement.

“Because most imaging by nonradiologists is self-referred, whereas radiologists generally do not have the opportunity to self-refer, this should be of interest and concern to policymakers and payors,” they wrote.


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