Imaging ranks near bottom of Medicare spending growth drivers

Reversing its role as a major contributor to the growth in Medicare spending in the early 2000s, medical imaging spending growth placed in the bottom 2 percent of spending growth categories in 2011, according to a study published in the December issue of the American Journal of Roentgenology.

“As a result of the slowdown in Medicare spending on imaging, other nonimaging services are now contributing much more to the overall increase in Medicare spending,” wrote Danny R. Hughes, PhD, research director and senior research fellow at the Harvey L. Neiman Health Policy Institute in Reston, Va., and colleagues. “Policy makers seeking further reductions in health care spending should consider directing future cost cutting initiatives toward these now-leading service categories.”

Previous studies have demonstrated a slowdown in imaging volume and spending growth over the second half of the last decade. The current study, however, focused on imaging growth relative to other big-ticket Medicare services. This distinction is important because policies aimed at bending cost curves generally target services with high relative growth rates rather than simply those with the largest absolute spending, according to the authors.

Hughes and colleagues tapped into data from the Physician Supplier Procedure Summary Master Files to calculate per-beneficiary Part B Medicare expenditures. A total of 44 Berenson-Eggers Type of Service (BETOS) categories, all representing services with at least $500 million in aggregate spending in 2011, were analyzed. Data from 32 million beneficiaries from 2000 to 2011 were included.

In the period prior to the Deficit Reduction Act (DRA), from 2000-2006, Medicare outlays for nonimaging services grew by 6.8 percent compared with 12 percent for imaging services. However, while spending on nonimaging services continued to grow at a 3.6 percent annual rate in the five years after the DRA, spending on imaging declined 3.5 percent annually, according to the study.

Of the 44 BETOS spending categories studied, advanced imaging ranked in the second percentile of Medicare spending growth. Standard imaging, ultrasound and cardiac/other imaging ranked 33rd, 34th and 39th, respectively.

In comparison, the fastest growing service categories from 2007 through 2011 were evaluation and management services with other specialists (29.1 percent growth), nursing home visits (11.2 percent), anesthesia (9.1 percent) and other ambulatory procedures (9 percent).

Hughes and colleagues cited a number of reasons for the slowdown in imaging spending growth. Payment reductions in the form of the DRA, multiple procedure payment reduction discounting and code bundling have all affected spending. Meanwhile, imaging volume growth has been curbed as technology has matured and as evidence-based guidelines and radiation reduction initiatives have spread. Advances such as clinical decision support and improved access to EMRs with previous imaging results have also reduced unnecessary imaging.

Following the publication of the study, the Medical Imaging & Technology Alliance (MITA) issued a statement echoing Hughes and colleagues’ call for policymakers to focus on other categories of spending when drafting further cost-cutting efforts.

“The important take away from this study for lawmakers is that imaging is no longer a high cost bull’s eye for Medicare reductions. Cost cutters must look elsewhere,” said Gail Rodriguez, executive director of MITA, in the statement.