Imaging did not contribute to an increase in Medicare spending between 2009-2019

Imaging did not contribute to an increase in Medicare spending between 2009 to 2019, despite claims to the contrary, according to a new analysis published Sunday.

Total U.S. healthcare expenditures hit $3.8 trillion two years ago, representing a fourfold increase in the sector’s share of the gross domestic product since 1960. That’s compelled efforts to reduce spending, with radiology one of the prime targets, University Hospitals Cleveland experts noted.

However, the specialty recorded the most negative compounded annual growth rate when compared to all other Medicare Part B categories during those 10 years. Imaging represented just 8% of Part B spending, 1.4% of total Medicare outlays and 0.05% of all national healthcare expenditures, researchers detailed in Current Problems in Diagnostic Radiology.

“These findings contradict statements that physician services and imaging are a significant contributing factor for the growth of expenditures and the disproportional amount the United States spends in healthcare compared to other countries,” corresponding author Keval Parikh, MD, with University Hospitals’ Department of Radiology, and colleagues wrote Aug. 29. “Further investigation of other components of the [national health expenditures] other than Part B, such as out-of-pocket expenditures and facility fees, may help clarify the total contribution that imaging has in the NHE.”

During the 10-year study period, payments per Part B service declined at a 1.4% compound annual growth rate. Imaging recorded the biggest drop at 3.5% among all categories. Within that segment, nuclear medicine saw the biggest dip at 7.4%, followed by MRI/MR angiography (-5.8%), CT/CTA (-3.5%) and ultrasound (-3.3%). Meanwhile, plain film X-rays logged a positive growth rate of 0.4%. There was a total of 5.1 billion services paid for in 2019, and imaging represented about 8% of that volume. CAGR for number of services was 2.1% during the study, and imaging recorded a 0.5% growth rate. And Part B expenditures totaled $115.6 billion by 2019, with a modest growth rate of 0.6%. That was driven by drugs (up 5.9%) and procedures (0.9%), at a time when imaging dropped 3%.

Despite these numbers, the federal government has targeted imaging spending for cuts on several occasions. Parikh et al. are concerned about the impact of continued pressure on imaging pricing.

“If price control leads to decrease in reimbursements to unsustainable and unfair levels, it may cause unintended consequences such as shortages of physicians and physician services, rationing, deterioration of quality (e.g., burnout), the creation of additional fees to patients and/or the increase in out-of-pocket expenditures,” the authors noted. “In fact, there is evidence that patients very commonly pay coinsurance when undergoing advanced imaging, both in and out of the network. This could be a sign of the unintended consequences of reduction in fee services beyond the equilibrium point for suppliers of Imaging services.”

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