Majority of imaging-related Medicare payments made to nonradiologists

More than half of all Medicare Physician Fee Schedule (MPFS) payments for medical imaging services in the U.S. are made to nonradiologists, according to study results published in the May issue of the American Journal of Roentgenology.

While medical imaging services are traditionally thought to be provided predominantly by radiologists, recent research has revealed an increasing amount of billing related to imaging by nonradiologists and other business entities. There are a variety of reasons for this growing trend, according to lead author David Rosman, MD, of Massachusetts General Hospital in Boston, and his colleagues. “As payment types evolve from traditional fee-for-service to various bundled, episodic, and capitated models,” wrote Rosman and colleagues, “an understanding of the proportional spending on medical imaging attributable to radiologists versus nonradiologists becomes increasingly important in establishing a baseline and framework for new payment models.”

Rosman and his team set out to identify regional variation and spending trends, both nationally and by state, in MPFS payments for imaging services. They conducted a randomized study of more than 2.5 million Medicare enrollees and calculated total professional-only, technical-only, and global MPFS spending by state and according to the U.S. Census Bureau for all Medicare Berenson-Eggers Type of Service–defined services related to medical imaging. They then analyzed and compared the data in the context of payments to radiologists versus those made to nonradiologists.

Their results showed that the total cost of imaging per enrollee came to $207.17, with $95.71 going to radiologists and $111.46 received by nonradiologists. A breakdown by type of MPFS imaging spending showed that nonradiologists received 21 percent of professional-only payments (for image interpretation), 85 percent of technical-only payments (for owned equipment) and 70 percent of global payments (both professional and technical). “Nationally, 53.8 percent of MPFS payments for medical imaging services are made to nonradiologists, who claim a majority of MPFS payments in most states dominated by noninterpretive payments,” wrote the researchers.

Rosman and his colleagues hope their research will help inform policymakers and facilitate future study into the cause of these variations, as well as provide a deeper analysis as to the effects of the MPFS spending trends. “This majority spending on nonradiologists may have implications in bundled and capitated payment models for radiology services,” wrote Rosman et al. “Medical imaging payment policy initiatives must consider the roles of all provider groups and associated regional variation.”