Cardiologists outpacing radiologists in MPI exams

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 - Myocardial Perfusion - SPECT
13N NH3 myocardial perfusion PET/CT study performed at rest and during adenosine vasodilator stress on a Biograph 16.
Source: Siemens Healthcare/Technical University of Munich, Germany

Radiologists’ leading role in hospital-based radionuclide myocardial perfusion imaging (MPI) appears to be in jeopardy as cardiologists began to outpace them in performing MPI examinations, according to a study published in March in the American College of Radiology. This shift is occurring against a backdrop of a small decrease in MPI usage between 2000 and 2010, the authors reported.

“Radiologists’ initially predominant role in hospital-based MPI has eroded recently, while that of cardiologists has strengthened. This seems related to a shift among cardiologists away from office practice and into hospital affiliations,” David C. Levin, MD, chair of the department of radiology at Thomas Jefferson University in Philadelpiha, and colleagues wrote.

In 1998, radiologists utilized MPI twice as much as cardiologists and this gap narrowed by 2006. However, coding changes for MPI examinations brought on by the Deficit Reduction Act enacted in 2007 led to a 16 percent reduction in Medicare technical component reimbursement for private office MPI. Meanwhile, many cardiologists sold their private practices or merged with hospitals.

“Many MPI examinations are self-referred by cardiologists, which can lead to a potential conflict of interest. For all these reasons, utilization patterns of this technology are of interest to those who determine health policy and pay for health care,” the researchers wrote.

The study sought to explore how decreased reimbursement affected utilization patterns among radiologists and cardiologists in private and hospital settings. It examined data from national Medicare Part B databases, between 2000 through 2010, with codes for MPI examinations (including PET) selected.

Usage of MPI technology peaked in 2006, flattened out, then tapered off more dramatically during the final two years studied, Levin et al reported. In the big picture, 88 per 1,000 Medicare beneficiaries received primary MPI examinations in 2006, but that number dropped to 76.9 by 2010. In private radiologist settings, MPI use declined by 33 percent from 2006 to 2010, but conversely, cardiologist hospital-based utilization jumped 9 percent from 2009 to 2010.

“From the perspective of the healthcare system as a whole, the shift of advanced cardiac imaging studies from offices to hospitals is an unfavorable development. That is because reimbursements for hospital-based advanced imaging are considerably higher than those paid to private offices,” Levin et al wrote.

Levin and colleagues concluded that given radiologists’ diminished role in performing MPI examinations as evident through this study, continuation of radiologist participation “will require their close attention to quality, service, maintenance of expertise, involvement in research, and in some instances collaboration with cardiologists.”