A different utilization story: Study of privately insured shows uptick in imaging

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The narrative on imaging utilization has typically been described as a meteoric rise in the middle of the last decade, but then a plateau and even a small drop in utilization in recent years. This may not be the whole story, however, as a study of imaging for commercially insured patients has found that a brief downturn in 2010 was followed by another increase in 2011.

Michal Horný, MSc, of Boston University School of Public Health, and colleagues sought to study imaging utilization and payment growth trends for privately insured patients, as most prominent recent studies had focused on the Medicare Part B fee-for-service population.

“The major decrease in payments in the Medicare Part B fee-for-service population occurred in 2007 after implementation of the Deficit Reduction Act of 2005. Therefore, it may be possible that health care providers sought to cover their losses from this regulation by charging higher amounts for services provided to patients with private insurance,” wrote the authors. “These cost-shifting questions warrant further study with market-by-market comparison methods.”

The study, published online May 9 in the Journal of the American College of Radiology, looked at the Truven Health Analytics MarketScan Commercial Claims and Encounters database, which contains more than 29 million individuals. Horný and colleagues focused on trends in utilization of and payments for CT, MRI, PET, and ultrasound procedures in the years 2007–2011.

Results showed that in 2009, utilization of outpatient CT, MRI, PET and ultrasound procedures peaked at 106 percent, 105 percent, 111 percent and 113 percent of the 2007 baseline levels, respectively. Adjusted payments for ultrasound and CT that year reached 123 percent and 122 percent of the 2007 baseline, respectively, but overall, the shares of payment for all diagnostic imaging remained relatively stable between 2007 and 2011.

Grow slowed between 2009 and 2010—use of CT and MRI actually dropped slightly—though by 2011, outpatient utilization of CT, MRI and ultrasound began increasing again. Adjusted payments for CT, MRI, PET, and ultrasound procedures in 2011 reached 117 percent, 113 percent, 119 percent, and 129 percent of their 2007 levels, respectively, according to the authors.

Horný and colleagues noted that patterns of utilization in the inpatient setting were similar to the outpatient setting, with the exception of inpatient PET, which rose between 2009 and 2010, and then declined between 2010 and 2011.

The authors credited the introduction of new CPT codes for combined abdomen and pelvis CT for cutting payments for doubled outpatient CT scans despite growth in utilization.

The findings from this study of commercially insured patients left Horný and colleagues concerned about future efforts to limit growth and spending. “Policymakers and insurers will be challenged to devise strategies for keeping imaging utilization and payments under control as millions of previously uninsured Americans become enrolled in commercial insurance plans available through federal and state health insurance exchanges and through Medicaid expansions now being created and implemented under the Affordable Care Act.”