Non-radiologist-performed imaging payments comprised substantial proportions of overall Medicare reimbursement for highly-reimbursed physicians in cardiology, vascular surgery and orthopedic surgery, according to research published online Nov. 2 in Current Problems in Diagnostic Radiology.
Non-radiologist providers are performing more diagnostic imaging examinations and imaging-guided interventions traditionally performed by radiologists, which has raised concerns regarding appropriate utilization, self-referral, care quality and patient costs, according to Andrew J. Degnan, MD, radiologist at the Children’s Hospital of Philadelphia in Philadelphia, Pennsylvania, and colleagues.
Medicare Provider Utilization and Payment Database information was evaluated for provider information regarding overall reimbursement for providers in anesthesiology, cardiology, emergency medicine, neurology, obstetrics and gynecology, orthopedic surgery, neurology and vascular surgery.
Reported imaging studies and payment information was taken from the 25 highest-reimbursed providers. Differences between numbers of imaging studies, types of imaging and payment amounts were noted based on provider specialty, according to the researchers.
Degnan and colleagues found the highest-reimbursed cardiologists received the greatest percentage of Medicare payments from imaging (18.3 percent). They were followed by providers in vascular surgery (11.6 percent), obstetrics & gynecology (10.9 percent), orthopedic surgery (9.6 percent), emergency medicine (8.7 percent), neurology (7.8 percent) and anesthesiology (3.2 percent).
Average imaging payments amongst highly-reimbursed non-radiologists were greatest for cardiology ($578,265), vascular surgery ($363,912) and orthopedic surgery ($113,634). Among highly-reimbursed specialists, the most common non-radiologist imaging payments were from ultrasound (45 percent) and cardiac nuclear medicine studies (40 percent).
“Future work needs to ascertain imaging appropriateness and quality of studies performed by practitioners not specifically trained in medical imaging to ensure high-quality, cost-effective patient care,” the researchers wrote.
Overall, Degnan and colleagues noted their study demonstrates a greater likelihood of financial motivation for self-referred imaging studies amongst these groups of physicians and may create additional issues at the clinical and federal levels.
“In addition to financial concerns, the practice of self-referral for economic gain presents a conflict-of-interest that undermines the physician-patient relationship,” according to the researchers. “Overutilization of studies by self-referring clinicians has been a major concern for the government and healthcare community for decades with several specialty societies including radiation oncology, interventional and diagnostic radiology supporting efforts to end exceptions for self-referral of in-office ancillary services.”