Levin David C, Rao Vijay M, Maitino Andrea J, Parker Laurence, Sunshine Jonathan H
Department of Radiology, Thomas Jefferson University Hospital and Jefferson Medical College, Philadelphia, Pennsylvania 19107, USA.
J Am Coll Radiol. 2004 Aug;1(8):549-52. doi: 10.1016/j.jacr.2004.01.022.
To ascertain changes in the utilization rates of diagnostic ultrasound among radiologists, cardiologists, and other physicians in recent years.
The nationwide Medicare Part B databases for 1993 and 2001 were searched in all ultrasound Current Procedural Terminology 4 codes, except for ophthalmic ultrasound and supervision and interpretation codes. Ultrasound examinations were categorized as general, vascular, breast, obstetric (very low in the Medicare population), and echocardiography. Using the Medicare physician specialty codes, utilization rates per thousand Medicare beneficiaries per year were calculated for radiologists, cardiologists, and other physicians for all codes in the five aforementioned categories.
Radiologists performed 24% of all ultrasound examinations in 2001. The overall utilization rate of ultrasound examinations among radiologists increased from 132.9 per thousand Medicare beneficiaries in 1993 to 166.3 in 2001, a 25% increase. Among cardiologists, the rate increased from 190.3 in 1993 to 356.1 in 2001, an 87% increase. The vast bulk of these examinations were echocardiograms, but cardiologists also had some involvement in vascular ultrasound. Among other physicians, the rate increased from 116.9 in 1993 to 167.0 in 2001, a 43% increase. The areas of greatest involvement by these other physicians were echocardiography, vascular ultrasound, and general ultrasound. Of the five ultrasound categories, echocardiography had by far the highest volume.
Nonradiologist physicians utilize ultrasound at much higher rates than radiologists, primarily reflecting the influence of echocardiography. Between 1993 and 2001, the ultrasound utilization rate grew over 3 times as rapidly among cardiologists as among radiologists; the rate among other physicians grew almost twice as rapidly as it did among radiologists. This raises the concern that self-referral may be leading to higher utilization and costs.
确定近年来放射科医生、心脏病专家及其他医生的诊断性超声使用率的变化情况。
检索了1993年和2001年全国医疗保险B部分数据库中所有超声当前操作术语4编码，但眼科超声以及监督和解读编码除外。超声检查分为普通、血管、乳腺、产科（在医疗保险人群中非常少见）和超声心动图检查。利用医疗保险医生专业编码，计算了放射科医生、心脏病专家及其他医生在上述五类所有编码下每年每千名医疗保险受益人的使用率。
2001年放射科医生进行了所有超声检查的24%。放射科医生的超声检查总体使用率从1993年每千名医疗保险受益人132.9次增至2001年的166.3次，增长了25%。心脏病专家的使用率从1993年的190.3次增至2001年的356.1次，增长了87%。这些检查绝大多数是超声心动图检查，但心脏病专家也参与了一些血管超声检查。在其他医生中，使用率从1993年的116.9次增至2001年的167.0次，增长了43%。这些其他医生参与最多的领域是超声心动图检查、血管超声检查和普通超声检查。在这五类超声检查中，超声心动图检查的数量迄今为止是最多的。
非放射科医生的超声使用率远高于放射科医生，这主要反映了超声心动图检查的影响。1993年至2001年期间，心脏病专家的超声使用率增长速度是放射科医生的3倍多；其他医生的使用率增长速度几乎是放射科医生的2倍。这引发了人们对自我转诊可能导致更高使用率和成本的担忧。
