Medicare imaging spending is down, with some variation by state

Medicare imaging spending is down overall, but the exact figures vary from state to state, according to findings made available by Andrew B. Rosenkrantz, MD, and colleagues at the American College of Radiology’s ACR 2015 Annual Meeting.

Nationally, spending on medical imaging has slowed down in recent years, but the presenters sought to drill down one step further. They used CMS data to study Medicare Part B imaging spending per beneficiary on a state-by-state basis from 2004 to 2012.

The data show that, in 49 of the 51 states (Washington D.C. was included), spending peaked in 2005 or 2006 before beginning a sudden decline.

“In just about every state, there was an abrupt, sustained change in 2006, though the extent of that change varied among the states,” Rosenkrantz told in a phone interview.

Rosenkrantz listed several factors that helped drive the change.

“We attribute the decline to many factors,” Rosenkrantz said. “It is changes in policy, such as the Deficit Reduction Act of 2005, Multiple Payment Procedure Reductions, increased litigation rates and expanded bundle codes. It is also environmental or situational factors such as the recession, growing concerns about radiation and greater impact of radiology benefit management companies. It’s a mix of policy and other situational factors.”

Maryland and Oregon are the two states that saw an increase in imaging spending, and this was due to their “unique state health plans,” the presenters explained.

“They received Medicare waivers and they were able to have their own plans, so they ended up having different trends,” Rosenkrantz said.

The waiver in Maryland’s case exempts hospitals from Medicare’s prospective payment systems, leading to higher rates for hospital services than in other states. In Oregon, a federal waiver greatly expanded coverage to individuals who would not have been insured otherwise, leading to increased access in the state.

“I think this shows the ability to have different local effects through local legislation,” Rosenkrantz said.