Day of Week, Site of Service, and Patient Complexity Disparities in Musculoskeletal MRI Interpretations by Radiologists Versus Nonradiologists.

OBJECTIVE: Although most musculoskeletal MRI examinations are interpreted by radiologists, some nonradiologists provide interpretations as well. We aimed to study day of week (weekday vs weekend), site of service, and patient complexity differences between radiologists and nonradiologists interpreting lower extremity MRI examinations on Medicare beneficiaries. MATERIALS AND METHODS: Using fee-for-service carrier claims for a 5% sample of Medicare beneficiaries nationally from 2012 through 2014, we identified all lower extremity joint MRI examinations. Services were classified by physician specialty, day of week, and site of service. Charlson comorbidity index (CCI) values were calculated for all patients. Chi-square statistical testing was performed. RESULTS: Of all 125,800 billed lower extremity joint MRI examinations, 118,295 (94.0%) were performed on weekdays and 7505 (6.0%) on weekends. Of the weekday examinations, radiologists interpreted 85,991 (83.3%) and nonradiologists 17,260 (16.7%). Of the weekend examinations, radiologists interpreted 6212 (92.8%) and nonradiologists 485 (7.2%). Of examinations performed in inpatient hospital and emergency department settings, radiologists interpreted 6499 (99.2%) and nonradiologists 51 (0.8%). Of the examinations on the most clinically complex patients (CCI ≥ 3), radiologists interpreted 4228 (90.2%) and nonradiologists 461 (9.8%). All interspecialty differences were statistically significant (p < 0.001). CONCLUSION: In the Medicare population, radiologists interpret most lower extremity joint MRI examinations. Compared with nonradiologists, radiologists disproportionately provide services on weekends, in the highest acuity settings, and on the most clinically complex patients. To promote patient access and minimize disparities, future pay-for-performance metrics should consider temporal, acuity, and complexity parameters.

Changing Musculoskeletal Extremity Imaging Utilization From 1994 Through 2013: A Medicare Beneficiary Perspective.

OBJECTIVE: The objective of our study was to assess temporal changes in the utilization of musculoskeletal extremity imaging in Medicare beneficiaries over a recent 20-year period (1994-2013). MATERIALS AND METHODS: Medicare Physician Supplier Procedure Summary Master Files from 1994 through 2013 were used to study changing utilization and utilization rates of the four most common musculoskeletal imaging modalities: radiography, MRI, CT, and ultrasound. RESULTS: Utilization rates (per 1000 beneficiaries) for all four musculoskeletal extremity imaging modalities increased over time: 43% (from 441.7 to 633.6) for radiography, 615% (5.4-38.6) for MRI, 758% (1.2-10.3) for CT, and 500% (1.8-10.8) for ultrasound. Radiologists were the most common billing specialty group for all modalities throughout the 20-year period, maintaining dominant market shares for MRI and CT (84% and 96% in 2013). In recent years, the second most common billing group was orthopedic surgery for radiography, MRI, and CT and podiatry for ultrasound. The physician office was the most common site of service for radiography, MRI, and ultrasound, whereas the hospital outpatient and inpatient settings were the most common sites for CT. CONCLUSION: In the Medicare population, the most common musculoskeletal extremity imaging modalities increased substantially in utilization over the 2-decade period from 1994 through 2013. Throughout that time, radiology remained the most common billing specialty, and the physician office and hospital outpatient settings remained the most common sites of service. These insights may have implications for radiology practice leaders in making decisions regarding capital infrastructure, workforce, and training investments to ensure the provision of optimal imaging services for extremity musculoskeletal care.

The Pursuit of Value in Musculoskeletal Imaging: Policy and Clinical Practice Intersect.

Rapidly rising health care costs coupled with variability in pricing and patient service have led to intense public scrutiny and pressure for health care providers to demonstrate value. Recent changes in legislation and payment models have intensified a shift from volume-based to value-based care, transferring risk from payers to providers. The American College of Radiology's Imaging 3.0 initiative encourages radiologists to become leaders in this changing health care landscape, helping to redefine value relative to health outcomes that matter to patients. Finding value and areas for improvement can prove difficult. However, through the imaging value chain, a plethora of opportunities are easily identifiable. It will be critical for musculoskeletal radiologists to leverage information technology and develop meaningful metrics to assess and demonstrate imaging's contribution to improved patient outcomes and reduction in costs, and to advocate for appropriate reimbursement.

Changing Utilization Patterns of Cervical Spine Imaging in the Emergency Department: Perspectives From Two Decades of National Medicare Claims.

PURPOSE: The aim of this study was to assess the changing use of emergency department (ED) cervical spine imaging in the Medicare population. METHODS: Using national aggregate Medicare claims data from 1994 through 2012, all cervical spine radiographic, CT, and MR examinations performed in the ED setting were identified. Shifts in modalities and providers and changes in utilization rates were studied. RESULTS: Between 1994 and 2004, ED cervical spine radiography volumes in the Medicare fee-for-service population increased from 203,645 to 306,442 (+50.5%) and then declined to 152,755 (-50.2%) by 2012. CT volumes increased every year, overall by +8,864% from 1994 through 2012 (from 6,360 to 570,121). MR grew by +1,381%, but volumes overall were small (from 944 to 13,979). With these changes, CT overtook radiography as the dominant ED cervical spine imaging modality in 2007. Per 1,000 Medicare beneficiaries, utilization rates of radiography, CT, and MR changed by -27%, +8,682%, and +1,351% from 1994 through 2012 (from 6.3 to 4.6, from 0.2 to 17.3, and from 0.0 to 0.4). For all years, compared with other specialists, radiologists remained by far the dominant providers of radiography, CT, and MR (+91.7%, +93.4%, and +96.0% in 1994 and +96.9%, +99.3%, and +99.0% in 2012) in the ED setting. CONCLUSIONS: Between 1994 and 2012, the overall utilization rate of cervical spine imaging for Medicare beneficiaries in the ED setting more than tripled. With a small decline in radiography (-27%) but a dramatic increase in CT (+8,864%), CT is now by far the dominant modality for imaging the cervical spine in the ED. Radiologists remain overwhelmingly the dominant providers of these interpretive services.