Study points to decreased—but possibly inappropriate—utilization of myocardial perfusion imaging

Recent trends indicate a decrease in the utilization of myocardial perfusion imaging—along with possible inappropriate use of the modality.

That’s the conclusion of a research team led by Sarah Kamel, MD, of Thomas Jefferson University Hospital’s Center for Research on Imaging Services in Philadelphia and presented in a study published in the Journal of the American College of Radiology.

“The objective of this study was to evaluate the most recent trends in the utilization of elective MPI among the Medicare population,” Kamel and colleagues wrote. “We wished to determine if the trends were reflective of recent reimbursement cuts and transition of place of service from private offices to hospital outpatient departments (HOPDs).”

The study involved a review of nationwide Medicare Part B fee-for-service databases for 2004 to 2016. The researchers analyzed two current procedural terminology (CPT) codes for stress MPI—standard planar and single-photon emission CT (STD) and PET—calculating rates per 1,000 Medicare beneficiaries.

Elective exams were identified using place-of-service codes for private offices and HOPDs, while Medicare physician specialty codes identified performing physicians.

Among study findings, elective STD MPI utilization was determined to have peaked in 2006, at 74 studies per 1,000 beneficiaries, and to have declined by 36% by 2016.

Research conducted by the team also revealed that, during the study period, cardiologists’ share of STD MPI performed increased from 79% to 87%, which topped that of radiologists or any other physicians.  

Additionally, STD MPI performed by cardiologists was determined to occur mostly in private offices, where utilization peaked in 2008 before declining to a rate of 28 such procedures per 1,000 studies by 2016.

From 2004 to 2016, administration of STD MPI by cardiologists demonstrated an absolute increase of 8.1 procedures per 1,000 studies, while radiologists’ use of STD MPI plummeted by 58%.

On the HOPD side, radiologists were found to have performed 4.8 exams per 1,000 Medicare beneficiaries in 2016, down from 10.8 such exams per 1,000 beneficiaries in 2004.

The researchers also identified a marked increase in cardiologists’ use of STD MPI in HOPDs, from 7.3 studies in 2008 to 15.4 studies in 2016.

These trends, the authors wrote, suggest that “some of the private office utilization might have represented inappropriate or unnecessary self-referral.”

Moreover, “although it is promising to see a decline in performance of STD MPI in private offices, the recent rapid increase in use of PET MPI, a much more costly procedure, in cardiology offices is of some concern.”