Diagnostic and Interventional Imaging Services are Significant Sources of Medicare Revenue for Highly-Reimbursed Non-Radiologist Providers

Publication date: Available online 2 November 2018

Source: Current Problems in Diagnostic Radiology

Author(s): Andrew J Degnan, Paul H. Yi, Nathan Kim, John Swietlik, Eric Huh, Jie C. Nguyen

Abstract

Introduction

Non-radiologist providers increasingly perform diagnostic imaging examinations and imaging-guided interventions traditionally performed by radiologists, which have raised concerns regarding appropriate utilization and self-referral. The purpose of this study was to assess the contribution of imaging studies to Medicare reimbursements for highly-compensated non-radiologist providers in specialties often performing imaging studies.

Methods

The Medicare Provider Utilization and Payment Database was queried for provider information regarding overall reimbursement for providers in anesthesiology, cardiology, emergency medicine, neurology, obstetrics & gynecology, orthopedic surgery, neurology and vascular surgery. Information regarding imaging studies reported and payment amounts were extracted for the 25 highest-reimbursed providers. Data was analyzed for relative contribution of imaging payments to overall medical Medicare payments.

Results

Significant differences between numbers of imaging studies, types of imaging, and payment amounts were noted based on provider specialty (p<0.001). Highest-reimbursed cardiologists received the greatest percentage of Medicare payments from imaging (18.3%) followed by vascular surgery (11.6%), obstetrics & gynecology (10.9%), orthopedic surgery (9.6%), emergency medicine (8.7%), neurology (7.8%) and anesthesiology (3.2%) providers. Mean imaging payments amongst highly-reimbursed non-radiologists were greatest for cardiology ($578,265), vascular surgery ($363,912) and orthopedic surgery ($113,634). Amongst highly-reimbursed specialists, most common non-radiologist imaging payments were from ultrasound (45%) and cardiac nuclear medicine studies (40%).

Conclusions

Non-radiologist performed imaging payments comprised substantial proportions of overall Medicare reimbursement for highly-reimbursed physicians in several specialties, especially cardiology, vascular surgery and orthopedic surgery. Further investigation is needed to better understand the wider economic implications of non-radiologist imaging study performance and self-referral beyond the Medicare population.

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