Danny R. Hughes

Comparative analysis of Medicare spending for medical imaging: sustained dramatic slowdown compared with other services.

OBJECTIVEnThe purpose of this study was to assess trends in Medicare spending growth for medical imaging relative to other services and the Deficit Reduction Act (DRA).nnnMATERIALS AND METHODSnWe calculated per-beneficiary Part B Medicare medical imaging expenditures for three-digit Berenson-Eggers Type of Service (BETOS) categories using Physician Supplier Procedure Summary Master Files for 32 million beneficiaries from 2000 to 2011. We adjusted BETOS categories to address changes in coding and payment policy and excluded categories with 2011 aggregate spending less than

How Much Do Common Imaging Studies Cost? A Nationwide Survey of Radiology Trainees.

500 million. We computed and ranked compound annual growth rates over three periods: pre-DRA (2000-2005), DRA transition period (2005-2007), and post-DRA (2007-2011).nnnRESULTSnForty-four modified BETOS categories fulfilled the inclusion criteria. Between 2000 and 2006, Medicare outlays for nonimaging services grew by 6.8% versus 12.0% for imaging services. In the ensuing 5 years, annual growth in spending for nonimaging continued at 3.6% versus a decline of 3.5% for imaging. Spending growth for all services during the pre-DRA, DRA, and post-DRA periods were 7.8%, 3.8%, and 2.9 compared with 15.0%, -3.4%, and -2.2% for advanced imaging services. Advanced imaging was among the fastest growing categories of Medicare services in the early 2000s but was in the bottom 2% of spending categories in 2011. Between 2007 and 2011, the fastest growing service categories were evaluation and management services with other specialists (29.1%), nursing home visits (11.2%), anesthesia (9.1%), and other ambulatory procedures (9.0%).nnnCONCLUSIONnSlowing volume growth and massive Medicare payment cuts have left medical imaging near the bottom of all service categories contributing to growth in Medicare spending.

State Variation in Medical Imaging: Despite Great Variation, the Medicare Spending Decline Continues

OBJECTIVEnThe objective of this study was to gauge the knowledge of radiology trainees regarding the costs of common imaging services and to assess their perceptions of current relevant education.nnnSUBJECTS AND METHODSnDuring mid-2014, an online survey of 5325 U.S. residents and fellows who were members of the American College of Radiology was conducted. Respondents were asked to provide information about year of training, relevant advanced degrees (e.g., Master of Business Administration or Master of Public Health), number of hours of formal education in health care economics provided annually by their training program, self-perception of knowledge of health care economics, and desire to learn more about the costs of imaging. Respondents were asked to estimate Medicare-allowable fees for five commonly performed imaging examinations: two-view chest radiography, contrast-enhanced CT of the abdomen and pelvis, unenhanced MRI of the lumbar spine, complete abdominal ultrasound, and unenhanced CT of the brain. Responses within ± 25% of published allowable amounts in the Medicare fee schedule were deemed correct.nnnRESULTSnA total of 1066 of 5325 trainees (20.0%) returned surveys that were sufficiently complete for analysis. Only 17.1% of all responses were correct; 65.3% of responses were overestimations of actual costs, and 17.6% were underestimations. Almost half of the trainees (45.1%) incorrectly estimated the cost of every examination. Overall, knowledge of costs of examinations did not improve with advancing years of training, hours of education in health care economics, or attainment of a relevant advanced degree. Only 9.3% of trainees considered their knowledge of imaging costs to be adequate. An overwhelming 89.7% of trainees desired more focused education.nnnCONCLUSIONnRadiology trainees have limited knowledge of the costs of commonly performed imaging studies. Effective training program curricula currently appear to be lacking. Targeted education and integration of cost information into clinical decision support tools are probably warranted.

The U.S. Radiologist Workforce: An Analysis of Temporal and Geographic Variation by Using Large National Datasets

OBJECTIVEnThe purpose of this study was to assess state-level trends in per beneficiary Medicare spending on medical imaging.nnnMATERIALS AND METHODSnMedicare part B 5% research identifiable files from 2004 through 2012 were used to compute national and state-by-state annual average per beneficiary spending on imaging. State-to-state geographic variation and temporal trends were analyzed.nnnRESULTSnNational average per beneficiary Medicare part B spending on imaging increased 7.8% annually between 2004 (

Generalist versus Subspecialist Characteristics of the U.S. Radiologist Workforce

350.54) and its peak in 2006 (

Percutaneous Hepatic and Renal Biopsy Procedures: An 18-Year Analysis of Changing Utilization, Specialty Roles, and Sites of Service

405.41) then decreased 4.4% annually between 2006 and 2012 (

Emergency Department Imaging: Uncompensated Services Rendered by Radiologists Nationwide

298.63). In 2012, annual per beneficiary spending was highest in Florida (

The effect of macroeconomic conditions on the care decisions of the employed.

367.25) and New York (

The Scope and Distribution of Imaging Services at Critical Access Hospitals

355.67) and lowest in Ohio (

An Integer Programming Approach for Evaluating R&D Funding Decisions With Optimal Budget Allocations

67.08) and Vermont (