Study: Imaging shifts from hospitals to private practices
David C. Levin, MD, from the department of radiology at Thomas Jefferson University Hospital and Jefferson Medical College in Philadelphia, and colleagues undertook the study to examine shifts in place of service for noninvasive diagnostic imaging (NDI) and determine whether hospitals have lost business to private outpatient imaging facilities.
The researchers studied Medicare Part B databases for 1996 through 2006 and calculated NDI utilization rates per 1,000 Medicare beneficiaries. They then compared the changes in utilization rates in hospital inpatient, hospital outpatient and hospital emergency departments (ED) over the course of the decade, with particular emphasis on possible outpatient NDI shifts between hospital outpatient departments and private offices or imaging centers.
Between 1996 and 2006, Levin and colleagues found that Medicare NDI utilization rates per 1,000 hospital inpatients increased 15 percent; ED NDI rates increased 77 percent; and hospital NDI outpatient rates increased 25 percent.
On the other hand, they found that private office NDI rates increased 63 percent. The investigators also reported that the total outpatient imaging rates (both hospital and office) increased 45 percent.
“As a result of the more rapid growth in private office imaging, hospitals’ share of this market dropped from 47 percent in 1996 to 41 percent in 2006. Private office imaging utilization rates between 1996 and 2006 grew by 71 percent among non-radiologist physicians, compared with 44 percent among radiologists,” the authors wrote.
The researchers attributed the shift to outpatient settings to three potential factors:
- Hospitals have been slow to add outpatient imaging capacity and that physicians and entrepreneurs have filled a gap in supply;
- Physicians and entrepreneurs have been more aggressive in adding new equipment in their offices and have driven demand up by a combination of marketing and self-referral; and
- Private offices may be patient preferences.
The authors concluded that Medicare NDI utilization rates increased in all places of service between 1996 and 2006, and because “NDI can be a profitable business, it seems that hospitals have lost an important opportunity.”