Uncompensated radiology services in ED open door for improved revenue management

Almost half of all uncompensated services by radiologists in the emergency department are provided to patients with insurance, illustrating room for revenue management improvement, according to a study published in the June issue of the Journal of the American College of Radiology.

The role of the emergency department (ED) as the safety net for the healthcare delivery system has implications for radiologists, who consequently render a substantial amount of uncompensated imaging services.

“Uncompensated care has long created patient access challenges, particularly in the ED setting, and is therefore important from a health policy perspective. Hospitals often struggle to maintain appropriate ED specialist coverage and are increasingly providing subsidies to physicians caring for their uninsured,” wrote lead author Richard Duszak, MD, of the Harvey L. Neiman Health Policy Institute in Reston, Va., and colleagues. The authors aimed to study the frequency, magnitude and other characteristics of uncompensated radiological services in the ED.

The researchers identified 18,475,491 ED patients who received radiological services from 2009 to 2012 in 40 states by using deidentified billing claims for 2,935 radiologists. Duszak and colleagues focused on 133 of 830 procedure codes that constituted 99 percent of all rendered services. To estimate service dollar values, the National 2012 Medicare Physician Fee Schedule amounts were used.

Of the radiologists included in the study, 2,835 offered uncompensated care to ED patients, which averaged to $2,584 in professional services per physician per service month. Radiologists did not receive any compensation for 28.4 percent of the services.

Eight procedure codes describing a variety of chest, foot and ankle radiographic and brain, abdominal, pelvic and cervical spine CT exams comprised 51 percent of all imaging services rendered to ED patients. Moreover, CT represented 31.2 percent of all services but contributed to 64.8 percent of uncompensated dollars.

The odds of radiologist payment increased by 8 percent for every $100 in total imaging charges, while every $100 in charges for uninsured patients reduced the odds of payment by 28 percent.

While the uninsured received 15.8 percent of all services, they were attributed to 52.3 percent of all uncompensated services. To the researchers’ surprise, 47.7 percent of all uncompensated services by radiologists in the ED are given to patients with insurance.

“Whatever the explanation, as uncompensated care receives increased attention as part of health care reform discussions, many opportunities clearly exist for further investigation,” wrote Duszak and colleagues.