David A. Rosman

Regional Variation in Medicare Payments for Medical Imaging: Radiologists Versus Nonradiologists

OBJECTIVE The purpose of this article was to study regional variation in Medicare Physician Fee Schedule (MPFS) payments for medical imaging to radiologists compared with nonradiologists. MATERIALS AND METHODS Using a 5% random sample of all Medicare enrollees, which covered approximately 2.5 million Part B beneficiaries in 2011, total professional-only, technical-only, and global MPFS spending was calculated on a state-by-state and United States Census Bureau regional basis for all Medicare Berenson-Eggers Type of Service-defined medical imaging services. Payments to radiologists versus nonradiologists were identified and variation was analyzed. RESULTS Nationally, mean MPFS medical imaging spending per Medicare beneficiary was

Sustainable growth rate 2013: time for definitive intervention

207.17 (

Dynamic left ventricular outflow tract obstruction induced by dobutamine stress echocardiography leading to myocardial ischemia and infarction

95.71 [46.2%] to radiologists vs

Radiology in Pioneer Accountable Care Organizations: Much Ado About Nothing?

111.46 [53.8%] to nonradiologists). Of professional-only (typically interpretation) payments, 20.6% went to nonradiologists. Of technical-only (typically owned equipment) payments, 84.9% went to nonradiologists. Of global (both professional and technical) payments, 70.1% went to nonradiologists. The percentage of MPFS medical imaging spending on nonradiologists ranged from 32% (Minnesota) to 69.5% (South Carolina). The percentage of MPFS payments for medical imaging to nonradiologists exceeded those to radiologists in 58.8% of states. The relative percentage of MPFS payments to nonradiologists was highest in the South (58.5%) and lowest in the Northeast (48.0%). CONCLUSION Nationally, 53.8% of MPFS payments for medical imaging services are made to nonradiologists, who claim a majority of MPFS payments in most states dominated by noninterpretive payments. This majority spending on nonradiologists may have implications in bundled and capitated payment models for radiology services. Medical imaging payment policy initiatives must consider the roles of all provider groups and associated regional variation.

Credentialing based on surgical volume, physician workforce challenges, and patient access.

Federal healthcare spending has been a subject of intense concern as the US Congress continues to search for ways to reduce the budget deficit. The Congressional Budget Office (CBO) estimated that, even though it is growing more slowly than previously projected, federal spending on Medicare, Medicaid and the State Childrens Health Insurance Program (SCHIP) will reach nearly

A Case of Posterior Loculated Tamponade Masquerading as an Atrial Mass on Transesophageal Echocardiography

900 billion in 2013. In 2011 the Medicare program paid

A rare case of Actinomyces israelii presenting as pericarditis in a 75-year-old man.

68 billion for physicians and other health professional services, 12% of total Medicare spending. Since 2002 the sustainable growth rate (SGR) correction has called for reductions to physician reimbursements; however, Congress has typically staved off these reductions, although the situation remains precarious for physicians who accept Medicare. The fiscal cliff agreement that came into focus at the end of 2012 averted a 26.5% reduction to physician reimbursements related to the SGR correction. Nonetheless, the threat of these devastating cuts continues to loom. The Administration, Congress and others have devised many options to fix this unsustainable situation. This review explores the historical development of the SGR, touches on elements of the formula itself and outlines current proposals for fixing the SGR problem. A recent CBO estimate reduces the potential cost of a 10-year fix of SGR system to

The Independent Payment Advisory Board

138 billion. This has provided new hope for resolution of this long-standing issue.

Accountable Care Organizations: Is the Radiologist at Risk?

Left ventricular outflow tract (LVOT) obstruction occurring during dobutamine stress echocardiography (DSE) occurs in approximately 15–20% of patients undergoing DSE. The clinical significance and mechanism of LVOT obstruction has been debated, but is now generally felt to result from the pharmacological effects of dobutamine in increasing inotropy and causing peripheral vasodilation. It must be realized that in rare instances, ischemia may occur and lead to wall motion abnormalities and eventually myocardial infarction. We present the case of a 70-year-old asymptomatic woman who underwent a routine pre-operative cardiac stress evaluation and was found to develop a dynamic outflow tract obstruction leading to myocardial ischemia and infarction.

Role of sagittal reformatted computed tomographic images in the evaluation of orbital floor fractures.

provide input on behalf of its members. As a quick refresher, an ACO is a team of providers that takes on the responsibility of coordinating care for a population and in turn accepts financial risk for providing that care [4]. An ACO participating in the Pioneer ACO Model commits to take on responsibility for all of the care for a population of at least 15,000 Medicare beneficiaries [5]. In exchange, the Pioneer ACO will continue to function in a fee-for-service environment, will share inbothupside and downside risk, and will garner a greater proportion of any shared savings, should these be generated by its efforts, than is the case with subsequent ACO models that involve only upside risk.