Imaging has become a frequent target of cost-containment efforts, and is frequently singled out as a significant contributor to rising healthcare costs. But, at least in terms of Medicare payments, most of the money spend on noninvasive imaging isn’t going to radiologists.
In fact, the opposite is true. Medicare payments for non-invasive diagnostic imaging (NDI), including magnetic resonance imaging (MRI) and computed tomography (CT) scans, are now higher to non-radiologists than to radiologists, according to a study in the January issue of the Journal of the American College of Radiology.
The reason is simple, says author David Levin, MD, of the department of radiology at Thomas Jefferson University Hospital in Philadelphia. It’s self-referral among non-radiologist physicians. Non-radiologists have become increasingly aggressive in their performance and interpretation of imaging, according to Levin and his colleagues. Urologists have CT scanners, orthopedists have MRIs—that that, he says, drives up healthcare costs.
It’s not a new revelation–at least not for radiologists.
“[W]e felt it would be of interest to study longer term trends in Medicare reimbursements to see if the common perception that radiologists receive most of the dollars paid to physicians for imaging is correct,” the authors wrote.
They looked at Medicare Part B files covering all fee-for-service physician payments for 1998 to 2008 and selected all codes for discretionary NDI. They found that the growth in fee-for-service payments to non-radiologists for NDI was considerably more rapid than the growth for radiologists between 1998 and 2006.
In 1998, overall Part B payments to radiologists for discretionary NDI were $2.563 billion, 27% higher than the $2.020 billion to non-radiologists. In 2008, non-radiologists received $4.807 billion for discretionary NDI; radiologists received $4.648 billion, the researchers report.
From 1998 to 2006, Medicare payments to non-radiologists increased by 166% versus 107% to radiologists. By 2006, non-radiologists were receiving more total payments than radiologists.
At the beginning of 2007, the Deficit Reduction Act of 2005 went into effect, and by 2008, payments to radiologists had been cut by 13%, and non-radiologists took an 11% cut
“Our data reveal the somewhat surprising finding that non-radiologist physicians are now paid more for NDI by Medicare than radiologists. This has come about because of more rapid growth in fee-for-service payments to non-radiologists between 1998 and 2006, followed by steeper losses among radiologists after implementation of the DRA in 2007,” says Levin.
The specialties with the highest Medicare payments for imaging were radiology, cardiology, primary care, and orthopedic surgery.
Because most imaging by non-radiologists is self-referred (whereas radiologists generally do not have the opportunity to self-refer), these findings should interest – and raise concerns for—policymakers and payers, Levin says. If policymakers, healthcare executives and other leaders want to control the costs of imaging, they need to either bar self referrals or significantly restrict them, he tells HealthLeaders Media. “This is what is driving up costs.”
His research, he says, drives home a point that many others have been making. But, he acknowledges, the issue of self-referrals is “a political hot potato.”