Levin David C, Rao Vijay M, Parker Laurence, Frangos Andrea J
Center for Research on Utilization of Imaging Services, Department of Radiology, Thomas Jefferson University Hospital and Jefferson Medical College, Philadelphia, Pennsylvania 19107, USA.
J Am Coll Radiol. 2009 Sep;6(9):620-5. doi: 10.1016/j.jacr.2009.05.010.
The Deficit Reduction Act of 2005 (DRA) sharply reduced technical component payments for private office magnetic resonance imaging (MRI) and computed tomographic (CT) imaging. Although radiologists have no control over referrals, nonradiologist physicians (NRPs) can potentially make up for revenue shortfalls by self-referring more examinations. The purpose of this study was therefore to compare the effects of the DRA on the in-office MRI and CT practices of radiologists and NRPs.
The nationwide Medicare Part B databases for 2002 to 2007 were studied. All MRI and CT codes were selected. Using Medicare physician specialty and place-of-service codes, examinations performed in private offices by radiologists were identified and compared with those performed by NRPs. Trends in procedure volume and payments were studied. The pre-DRA compound annual growth rates for 2002 to 2006 and the post-DRA one-year rates for 2007 are reported.
For MRI, radiologists' private office volume increased by 8.4% yearly from 2002 to 2006 but then dropped by 2.0% in 2007. Nonradiologist physicians' office volume increased by 24.8% yearly, then increased by another 7.6% in 2007. Office MRI payments to radiologists increased by 11.2% yearly from 2002 to 2006 but then dropped by 30.1% in 2007. Nonradiologist physicians' office MRI payments increased by 25.7% yearly, then dropped by 23.5% in 2007. For CT imaging, radiologists' private office volume increased by 11.2% yearly from 2002 to 2006 but then increased by only 2.9% in 2007. Nonradiologist physicians' office volume increased by 31.8% yearly, then increased by another 18.1% in 2007. Office CT payments to radiologists increased by 13.4% yearly from 2002 to 2006 but then dropped by 5.2% in 2007. Nonradiologist physicians' office CT payments increased by 34.9% yearly, then increased by another 8.3% in 2007.
After the DRA took effect, office MRI volume dropped among radiologists but increased among NRPs. Payments for MRI to both dropped, but the percentage decrease to radiologists was greater. Office CT volume increased slightly among radiologists but increased much more among NRPs on a percentage basis. Payments for CT imaging to radiologists dropped, but they increased to NRPs. These results suggest that NRPs may be able to ameliorate the effects of the DRA by increasing self-referral. These trends are of concern and should be scrutinized in future years.
2005年《减赤法案》（DRA）大幅削减了私人诊所磁共振成像（MRI）和计算机断层扫描（CT）成像的技术组件费用。尽管放射科医生无法控制转诊，但非放射科医生（NRP）有可能通过自行转诊更多检查来弥补收入缺口。因此，本研究的目的是比较DRA对放射科医生和NRP在诊所内进行MRI和CT检查的影响。
研究了2002年至2007年全国医疗保险B部分数据库。选取了所有MRI和CT代码。利用医疗保险医生专业和服务地点代码，确定并比较了放射科医生在私人诊所进行的检查与NRP进行的检查。研究了检查量和费用的趋势。报告了2002年至2006年DRA实施前的复合年增长率以及2007年DRA实施后的一年增长率。
对于MRI，放射科医生在私人诊所的检查量从2002年到2006年每年增长8.4%，但在2007年下降了2.0%。非放射科医生在诊所的检查量每年增长24.8%，然后在2007年又增长了7.6%。2002年至2006年，放射科医生在诊所的MRI检查费用每年增长11.2%，但在2007年下降了30.1%。非放射科医生在诊所的MRI检查费用每年增长25.7%，然后在2007年下降了23.5%。对于CT成像，放射科医生在私人诊所的检查量从2002年到2006年每年增长11.2%，但在2007年仅增长了2.9%。非放射科医生在诊所的检查量每年增长31.8%，然后在2007年又增长了18.1%。2002年至2006年，放射科医生在诊所的CT检查费用每年增长13.4%，但在2007年下降了5.2%。非放射科医生在诊所的CT检查费用每年增长34.9%，然后在2007年又增长了8.3%。
DRA生效后，放射科医生在诊所的MRI检查量下降，但NRP的检查量增加。两者的MRI检查费用均下降，但放射科医生费用的下降幅度更大。放射科医生在诊所的CT检查量略有增加，但NRP的检查量按百分比计算增加得更多。放射科医生的CT成像检查费用下降，但NRP的费用增加。这些结果表明，NRP可能能够通过增加自行转诊来减轻DRA的影响。这些趋势令人担忧，未来几年应予以审视。
