In looking at aggregate procedure counts in Medicare Part B medical imaging over the past eight years, the drama that unfolded between 2003 and 2010 is nowhere to be seen. Both rapid escalation in the imaging growth rate and a subsequent, nearly equivalent decline in volumes are lost in a compound annual growth rate (CAGR) of –0.9% over eight years. That’s according to a new analysis of the Medicare Physician/ Supplier Procedure Summary annual master files, 2003 to 2010, performed by the newly established Harvey L. Neiman Health Policy Institute (HPI). The HPI provided three tables based on partially scrubbed Medicare Part B data for 2003 through 2010. Imaging-service unit counts, by imaging modality, performed by radiologists and nonradiologists, were presented for the office setting (Table 1) and for all places of service (Table 2). Also provided was a breakdown of radiologists’ and nonradiologists’ shares of imaging in office; inpatient hospital; and hospital outpatient, emergency-department, or other settings (Table 3). Radiology Business Journal compared the imaging-service units of radiologists and nonradiologists to arrive at the growth rate for 2003 through 2007, when imaging hit its peak number of units in this population (Table 4). We also looked at the percentage change in units between 2007 and 2010, a period during which the number of imaging procedures performed in this population declined by 15% (Table 5), as well as the change in the same period in the office setting only (Table 6). We then looked at the changes in the site of service between 2003 and 2010 (see figure).
A few cautionary notes about the data, lest readers be inclined to draw more than is warranted from the numbers: Imaging counts, in IDTF settings, are included in the nonradiologist imaging category. CMS counts IDTF imaging not as a place of service, but as a specialty—and due to the inability to separate radiologist-owned IDTFs from other IDTFs, IDTF imaging is included in the nonradiologist counts. What would appear to be a dramatic decline in nuclear imaging from 2009 to 2010 and a smaller (but significant) decline in mammography are both the results of a CMS decision to bundle certain myocardial-imaging and mammography codes. Spike and Decline Over the eight-year span of 2003 through 2010, volumes dropped slightly in 2004 and then hit their peak in 2007 (Table 2), the year that the DRA reductions were fully implemented. Medicare paid for a total of 218,826,552 units of medical imaging in 2007, after which imaging volumes steadily declined by 15% over the next three years (Table 5). The decline was even more pronounced in the office setting (Table 6), where imaging volumes declined by 25% between 2007 and 2010. Danny Hughes, PhD, research director and senior research fellow at the HPI, says, “It’s a fresh story, but it’s also an old story. No one who deals with these data is surprised anymore that imaging has slowed down; in 2007, you had a marked drop-off in imaging.”
Hughes says that the HPI will be issuing its first policy brief addressing this and providing in-depth analysis. He attributes a small part of the decline to the DRA and other health policies—and a more significant portion to technology maturation. “There was a period, in the early 2000s, where you really had a ramping up,” he notes, adding that high-end technology has begun to diffuse. “Once you have the latest and greatest in these technologies, and the technologies are fully diffused, utilization adjusts to account for these new technologies and their use—then, it plateaus,” he says. Hughes is not projecting further declines, and he anticipates that volumes will plateau (except, perhaps, in rural areas, where access to imaging centers and technology is currently limited). Long and Short Views The broad trend in imaging-volume reductions over eight years (Tables 1–3) indicates that volumes for imaging performed by radiologists appear to have declined slightly more than those for imaging performed by nonradiologists in the office setting, but less than for nonradiologist-performed imaging in all settings. When viewed over the past three years, however, the drop in volumes has taken a greater toll on nonradiologist-performed imaging, and that’s true in all settings. In the office setting, radiologist-performed