Characteristics of COVID-19 Community Practice Declines in Noninvasive Diagnostic Imaging Professional Work.

PURPOSE: The operational and financial impact of the widespread coronavirus disease 2019 (COVID-19) curtailment of imaging services on radiology practices is unknown. We aimed to characterize recent COVID-19-related community practice noninvasive diagnostic imaging professional work declines. METHODS: Using imaging metadata from nine community radiology practices across the United States between January 2019 and May 2020, we mapped work relative value unit (wRVU)-weighted stand-alone noninvasive diagnostic imaging service codes to both modality and body region. Weekly 2020 versus 2019 wRVU changes were analyzed by modality, body region, and site of service. Practice share χ2 testing was performed. RESULTS: Aggregate weekly wRVUs ranged from a high of 120,450 (February 2020) to a low of 55,188 (April 2020). During that -52% wRVU nadir, outpatient declines were greatest (-66%). All practices followed similar aggregate trends in the distribution of wRVUs between each 2020 versus 2019 week (P = .96-.98). As a percentage of total all-practice wRVUs, declines in CT (20,046 of 63,992; 31%) and radiography and fluoroscopy (19,196; 30%) were greatest. By body region, declines in abdomen and pelvis (16,203; 25%) and breast (12,032; 19%) imaging were greatest. Mammography (-17%) and abdominal and pelvic CT (-14%) accounted for the largest shares of total all-practice wRVU reductions. Across modality-region groups, declines were far greatest for mammography (-92%). CONCLUSIONS: Substantial COVID-19-related diagnostic imaging work declines were similar across community practices and disproportionately impacted mammography. Decline patterns could facilitate pandemic second wave planning. Overall implications for practice workflows, practice finances, patient access, and payment policy are manifold.

Emergency department imaging: uncompensated services rendered by radiologists nationwide.

PURPOSE: The aim of this study was to examine characteristics of uncompensated services rendered by radiologists to emergency department (ED) patients. METHODS: Using deidentified billing claims for 2,935 radiologists from 40 states from 2009 through 2012, 18,475,491 services rendered to ED patients were identified. Analysis focused on the 133 of 830 procedure codes that comprised 99.0% (18,296,734) of all rendered services. The frequency, magnitude, and other characteristics of uncompensated (defined as zero payment) radiologist services were analyzed. National 2012 Medicare Physician Fee Schedule amounts were used to estimate service dollar values. RESULTS: Of 2,935 radiologists, 2,835 (96.6%) provided uncompensated care to ED patients, averaging $2,584 in professional services per physician per service month. Radiologists received no compensation at all for 28.4% of services (5,194,732 of 18,296,734). Just 8 procedure codes describing various chest, foot, and ankle radiographic and brain, abdominal and pelvic, and cervical spine CT examinations accounted for 51.0% of all imaging services rendered to ED patients. CT represented 31.2% of all services but accounted for 64.8% of uncompensated dollars. Although the uninsured received only 15.8% of all services, they accounted for 52.3% of all uncompensated services (2,714,506). CONCLUSION: More than 28% of services rendered by radiologists to ED patients are uncompensated, corresponding to $2,584 per month per physician. That frequency and magnitude could have patient access implications.