Some nonradiologists receive a high percentage of Medicare payments for performing imaging exams

Nonradiologists are performing more diagnostic and interventional imaging examinations now than ever before. In fact, according to a new study published in Current Problems in Diagnostic Radiology, reimbursements for those services make up a significant proportion of overall Medicare payments for many highly-reimbursed physicians from a variety of specialties.

“Over the years, there have been recurrent concerns in the radiology community over so-called turf wars in which radiologists compete with nonradiologist providers for patients and associated procedures in the same geographic region or institution,” wrote author Andrew J. Degnan, MD, department of radiology at Children’s Hospital of Philadelphia, and colleagues. “More important, however, are concerns regarding appropriateness, quality and costs associated with non-radiologist performed imaging studies. Although these trends in imaging study performance by other specialties began over a decade ago and are well-acknowledged in cardiac imaging and peripheral vascular interventions, there are concerns of ever-growing expansion of non-radiologist performed imaging services including various aspects of diagnostic imaging.”

The authors studied Medicare Provider Utilization and Payment Database data for providers in anesthesiology, cardiology, emergency medicine, neurology, obstetrics & gynecology, orthopedic surgery, neurology and vascular surgery. They then focused on the 25 highest-reimbursed providers to explore ongoing themes.

Overall, Degnan and colleagues found the highest-reimbursed cardiologists received more than 18 percent of their total Medicare reimbursements for imaging-related examinations. The percentages were also notably high for vascular surgery (11.6 percent), obstetrics and gynecology (10.9 percent), orthopedic surgery (9.6 percent) and emergency medicine (8.7 percent).

“Our findings note substantial proportions of Medicare payments to highest-reimbursed specialists in some specialties including cardiology and vascular surgery come from imaging studies,” the authors wrote. “While these findings imply a clear financial role for self-referral, this observational study cannot assess individual providers’ motivations or clinical necessity of the imaging services performed.”

Forty-five percent of the diagnostic imaging examinations these specialists performed were ultrasound examinations, making it the single most common. More than 75 percent of studies billed to cardiologists, on the other hand, were nuclear medicine studies of the heart. Emergency medicine providers would occasionally receive reimbursements for performing MRI or a cardiac nuclear medicine study, but they primarily performed ultrasounds and x-rays.

The authors also noted that more research is needed to focus on imaging appropriateness and the quality of these studies.