Medicare utilization of outpatient imaging services is beginning to shift from private offices to hospital settings, according to a recent study published in the Journal of the American College of Radiology.

The change, the authors wrote, seems to be a result of cuts to imaging reimbursements, primarily the 2005 Deficit Reduction Act and the widespread bundling of imaging-related CPT codes from 2009 to 2011. They fear this could lead to less access and higher costs for patients.

Bhavik Patel, MD, of the department of radiology at Thomas Jefferson University Hospital in Philadelphia, and colleagues studied Medicare data from 2001 to 2013. They used CPT codes to track the usage of MRI, echocardiography, nuclear medicine, ultrasound, and CT in each year, focusing on noninvasive procedures only. Place-of-service codes were used to determine if the services were provided in a private office or hospital outpatient department (HOPD).

Overall, the data shows that the utilization of all advanced imaging modalities performed in private offices grew 83% from 2001 to 2008. Then, due to the drastic code bundling, that number took a hit, decreasing 42% by 2011.

Advanced imaging utilization in HOPDs shows a similar trajectory—rising 26% from 2001 to 2008 and then declining 20% in 2011—until the two years following the bundling, when the outpatient settings went in different directions. From 2011 to 2013, utilization in private offices dropped another 9% while it increased 7% in HOPDs.

This development has Patel and his co-authors worried about the future of advanced imaging.

“These changes suggest that outpatient advanced imaging is beginning to shift out of private offices and into HOPDs, which is of concern for several reasons,” the authors wrote. “First, Medicare and the commercial payers pay more to hospitals for these studies than they do to private offices, so costs will increase. Second, although no firm data indicate the number of private office imaging facilities in the United States, reductions in private office utilization likely mean that some of these facilities are closing, probably as a result of the many reductions in imaging reimbursement in recent years.”

The authors also listed a third reason to be concerned: private offices, as a general rule, offer quicker service and “more pleasant” patient visits.

“At a time when patient-centered care has become paramount, the patient experience may suffer,” the authors wrote.

It will be important to watch these trends in the years ahead, the authors concluded, to see if their concerns become a reality or if the utilization numbers balance out as time goes on.