CT and MRI: Regional Variations in Utilization and Reimbursement

Provided by Regents Health Resources

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Regents Health Resources was formed in 1996 to assist hospitals and physicians in the development and management of their medical-imaging and oncology services. The consultancy has served more than 500 clients nationwide with a diverse range of services, from strategic planning and operational assessments to joint-venture planning, valuations, and imaging-center sales and acquisitions.


Introduction: Imaging operations need to understand current utilization rates and patterns in their local markets to deter- mine their relative rates of exam capture and to plan for future needs. This issue of Imaging Market File looks at national utilization rates (per 1,000 people) for outpatient CT and MRI procedures, ac- cording to Thomson Reuters (New York, New York) by age and by region (Table 1) as defined by AHRA: The Association for Medical Imaging Management. Reimbursement rates were based on Medicare outpatient rates from the Medicare Physi- cian Fee Schedule (MPFS) of 2010, 2011, and 2012, and were calculated by averag- ing regional CPT® code mixes.


Table 1. AHRA Regions


Growth stalls: Considering that the US population grew at an annual rate of 0.71% between 2010 and 2011 (Table 2), according to Thomson Reuters, and that the first members of the baby-boom generation—which the US Census Bureau estimates to represent a quarter of the population—turned 65 in 2011, factors other than demographics appear to have stunted growth in medical imaging (Tables 3 and 4).


Table 2. Population, by Region


CT utilization rates are down: The area demonstrating the highest utilization rate for CT is the East South Central region, at 176.78 exams per 1,000 people, with a growth rate of 0.75%—just slightly above national average population growth (Table 5). This region also experienced the largest drop in reimbursement, resulting in an annual decline of 4.56% from 2010 to 2012 (Figure 1). In contrast, the Pacific region comes in with the lowest utilization rate, at 131.96 exams per 1,000 people, and had growth of 0.79% (less than that region’s population growth of 1.04%). The West South Central region demonstrates the lowest percentage of utilization change for CT, at 0.58%, while also enjoying the least change as a percentage of reimbursement, at 1.77%


Table 3. CT Exams per 1,000 People


Figure 1. Average reimbursement per CT scan hit a high-water mark in 2011 in all US regions. Overall, reimbursement declined 3.07% per year between 2010 and 2012.


MRI utilization rates: With a 0.41% increase in utilization between 2010 and 2011, the 2.7% annual increase in MRI reimbursement between 2010 and 2012 belies the fact that MRI reimbursement in all regions declined in 2012 (Figure 2). The high-water mark for CT and MRI reimbursement appears in 2011, when rates for both modalities were highest. The region with the smallest population growth, North Central, had the lowest utilization rate for MRI and the third-lowest MPFS reimbursement. New England displayed the lowest increase in MRI utilization, at 0.19%.


Table 4. MRI Exams per 1,000 People


Figure 2. MRI utilization increased 0.41% between 2010 and 2011, and reimbursement increased 2.7% between 2010 and 2012. Between 2011 and 2012, however, MRI reimbursement in all regions declined.


Regional utilization (by age): The Mountain region’s utilization-rate growth from 2010 to 2011 exceeded that of all other regions, in every age group, with a total change of 0.96% while the population grew at a rate above the national average, at 1.38% (Table 6). MRI utilization in the Mountain states demonstrated the largest increase from 2010 to 2011 (0.64%) and the biggest three-year annual growth rate (3.37%). Reimbursement rates for 2012 are lower than for 2011, but higher than for 2010. When each region’s utilization growth is compared with its population growth, the data indicate that utilization growth, overall, is being outpaced by population growth.


Table 5. CT Exams per 1,000 People, by Region and Age


Table 6. MRI Exams per 1,000 People, by Region and Age


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