Per-patient imaging utilization, RVUs leapt during the pandemic despite overall drops in radiology volumes

Per-patient imaging utilization leapt during the early days of the pandemic, despite precipitous overall drops in radiology volumes, according to a new analysis.

Numerous studies have detailed COVID-19’s outsized impact on the specialty, as mammography and other healthcare services grinded to a halt due to stay-at-home orders and social-distancing policies. But new data reveal that—excluding respiratory complaints—individuals underwent 33% more studies compared to 2019 levels, while per-patient RVUs also climbed 24%.  

Reasons for this uptick are likely multifactorial, Massachusetts General Hospital emergency radiologist Marc Succi, MD, and colleagues wrote June 7 in Clinical Imaging.

“Clinical uncertainty in the diagnosis and management of COVID-19 may have spurred increased diagnostic testing by clinicians regardless of presenting complaint, thereby leading to increased imaging,” researchers speculated. “Further, as many patients began to avoid the healthcare system to reduce risk of exposure to COVID-19, the average acuity of patients presenting to the ED may have increased.”

To reach their conclusions, Succi et al. analyzed data from their large, urban emergency department, logged between April 1 to May 1 of 2020, comparing it to the same period of 2019. They separated patients into three groups: those presenting with respiratory illnesses, those without, and all combined.

Total patients plummeted by 41% year over year, while imaging exams dropped 24% (from 8,765 down to 6,624). Meanwhile, work relative value units (wRVUs) dropped 36%, with the percentage of patients receiving imaging going from 67% in 2019 down to 51% during the pandemic, Succi and colleagues reported.

Despite this contraction, there was a 7% increase in RVUs on a per-patient basis and 27% uptick in imaging studies. When focusing solely on the nonrespiratory presenting patients, those numbers increased to 24% and 33%, respectively. Mass General saw a 170% relative increase in patients presenting to the ED with respiratory complaints, however, this group averaged just 53% of the RVUs per patient when compared to nonrespiratory subjects.

“This double financial hit, comprised of absolute volume contraction and increased proportion of lower-value wRVU volume, is significant and can be taken into account by financial managers at all practices—for forecasting quarterly revenue or preparing for additional surges of this or other pandemics,” the authors advised.

Read more about their findings in the New York Roentgen Society’s medical journal here.

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