Pearlman Alan S, Ryan Thomas, Picard Michael H, Douglas Pamela S
Division of Cardiology, Department of Medicine, University of Washington Medical Center, Seattle, Washington, USA.
J Am Coll Cardiol. 2007 Jun 12;49(23):2283-91. doi: 10.1016/j.jacc.2007.02.048. Epub 2007 May 25.
We studied the use of echocardiography among Medicare beneficiaries between 1999 and 2004 to determine the rate of growth in these services and evaluate the drivers of growth.
Concerned about increasing health care costs, federal and private payers have highlighted growth in diagnostic imaging studies and begun to develop approaches to curb this growth.
Medicare Part B Physician/Supplier Procedure Summary Master File and enrollment data from 1999 to 2004 were reviewed. Total Medicare carrier-paid spending for echocardiography services was determined from procedure volumes and allowed charges. The 5% standard analytic file of physician claims was used to evaluate geographic variations in use and to document the specialties of physicians who request and those who interpret echocardiograms.
Between 1999 and 2004, echocardiography services grew at a rate similar to that for all medical services subject to Medicare's sustainable growth rate (SGR) calculation. Increasing provision of echocardiograms in physicians' offices contributed to increased spending under the SGR. Accounting for this shift, actual annualized per capita growth in echocardiography was 7.7%. Variations in the prevalence of heart disease contributed to geographic variations in use. Although cardiologists were the most common providers of echocardiographic services, primary care physicians ordered the majority of these diagnostic procedures.
Growth in the use of echocardiography is in keeping with the general growth in medical services. Nonetheless, physicians who order echocardiograms and those who provide them must work together to ensure that in the future these diagnostic services are used appropriately and not excessively.
我们研究了1999年至2004年间医疗保险受益人群中超声心动图检查的使用情况，以确定这些服务的增长率，并评估增长的驱动因素。
由于担心医疗保健成本增加，联邦和私人支付方强调了诊断成像研究的增长，并开始制定抑制这种增长的方法。
回顾了1999年至2004年医疗保险B部分医生/供应商程序汇总主文件和参保数据。根据程序量和允许收费确定医疗保险承保人支付的超声心动图服务总支出。使用医生索赔的5%标准分析文件来评估使用情况的地理差异，并记录申请和解读超声心动图的医生的专业。
1999年至2004年间，超声心动图服务的增长率与医疗保险可持续增长率（SGR）计算范围内的所有医疗服务的增长率相似。医生办公室超声心动图检查的增加导致了SGR下支出的增加。考虑到这一变化，超声心动图实际人均年化增长率为7.7%。心脏病患病率的差异导致了使用情况的地理差异。虽然心脏病专家是超声心动图服务最常见的提供者，但大多数此类诊断程序是由初级保健医生开出的。
超声心动图使用的增长与医疗服务的总体增长一致。尽管如此，开出超声心动图检查的医生和提供这些检查的医生必须共同努力，以确保未来这些诊断服务得到适当而非过度的使用。
