Increasing role for radiologists in thoracic diagnosis

Radiologists increased their market share of thoracic biopsies from 1998 to 2010, performing almost all of the percutaneous biopsies within the Medicare population, and consequently playing an important role in the diagnosis of thoracic disease, according to a study published in the October issue of the Journal of the American College of Radiology.

Richard Sharpe, Jr., MD, MBA, of Thomas Jefferson University Hospital in Philadelphia, and colleagues determined the previously unknown rate of thoracic biopsies by type in order to examine the utilization rate of thoracic biopsies within the Medicare population. Gathered data came from the CMS Part B Physician/Supplier Procedure Summary Master Files (PSPSMFs) for 1998-2010. The PSPSMFs summarize complete billing records for all procedures paid under Medicare Part B. Billing claims were analyzed for percutaneous thoracic biopsy, bronchoscopic thoracic biopsy, and surgical thoracic biopsy. 

Results indicated that the overall volume of both bronchoscopic and surgical biopsies decreased from 1998 to 2010, with rates of use dropping from 3.36 to 2.70 per 100,000 beneficiaries and 0.43 to 0.34 per 1,000 beneficiaries, respectively. The volume of percutaneous biopsies, however, increased significantly from 1998 to 2010, from 1.67 to 1.73 per 1,000 beneficiaries. Radiologists performed 96.4 percent of all percutaneous biopsies, and saw their total thoracic biopsy market share increase from 26.2 percent in 1998 to 35 percent in 2010.

Sharpe and colleagues' findings document an emerging trend of reliance on less invasive techniques to perform surgeries that previously required an open surgical approach. The use of percutaneous biopsies in the Medicare population has expanded over time, with a significant decline in use of surgical thoracic biopsy and bronchoscopic biopsy. Radiologists have experienced a steady increase in market share of thoracic biopsies, and therefore serve an important role in the diagnosis of thoracic disease.

“This may be the result of changing trends toward minimally invasive procedures, as well as changing patterns of reimbursement and increased availability of percutaneous biopsy," wrote the authors. "Increased rates of chest CT utilization seem to also be associated with decreased rates of thoracic biopsies, suggesting that radiologists may also be increasingly important in the noninvasive evaluation of thoracic disease.”