Abdominal imaging utilization rates as a whole have declined in recent years, due in part to code bundling and a decreased reliance on radiation-emitting modalities.
That’s according to a study of Medicare Part B data and current procedural terminology codes for 2004 through 2016, published May 26 in the American Journal of Roentgenology. Much of the decline was due to radiologists forgoing abdominal radiography, gastrointestinal fluoroscopy, and nuclear imaging.
Michael R. Kramer, MD, with Thomas Jefferson University Hospital, and colleagues did report that abdominal CT, CT angiography, MRI and MR angiography utilization have increased, but noted measures to stem the growth in abdominal scanning between 1996 and 2005 appear to have worked.
“In the early years, the overall rate continued to increase, but after 2006, it remained relatively flat through 2010,” Kramer, a radiologist at the Philadelphia institution, and colleagues added. “The large drop in 2011 resulted primarily from code bundling. Thereafter, the overall rate declined slowly.”
The researchers also attributed the gains to federal policy changes designed to derail the rapid rise in imaging use between 2000 and 2007. They pointed to the Deficit Reduction Act of 2005, reimbursement reductions, and revaluations of practice expenses.
Diving into the specific numbers, total abdominal imaging utilization dropped from 558 exams per 1,000 Medicare beneficiaries in 2004 to 441.9 in 2016—a nearly 21% decline. Additional figures include the following:
- CT and CTA exams increased by 22.5% from 2004 to 2010, but fell dramatically in 2011 because of code bundling. Then from 2011 to 2016, utilization for those modalities increased by a moderate 7.2%.
- Radiologists’ reliance on radiography dropped from 129.6 exams per 1,000 beneficiaries in 2004 to 91.5 in 2016, a 29.4% decline.
- Radionuclide studies dropped by 32.1% over the 12-year study period, and gastrointestinal fluoroscopy use plummeted by 40.5%.
- From 2004 to 2016, ultrasound use jumped by 1.5%.
- MR and MRA utilization, however, “sharply” increased on a percentage basis of 81.2%.
- Radiologists performed a majority of abdominal imaging, with a market share of 87% during the duration of the study.
The study did not determine the appropriateness of ordered tests and did not include those ordered for privately insured patients, the authors noted. But they added that the low rates of self-referrals have also helped stabilize abdominal imaging use.
Matt joined Chicago’s TriMed team in 2018 covering all areas of health imaging after two years reporting on the hospital field. He holds a bachelor’s in English from UIC, and enjoys a good cup of coffee and an interesting documentary.