1 Department of Radiology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit St, Boston, MA 02114.
AJR Am J Roentgenol. 2015 May;204(5):1042-8. doi: 10.2214/AJR.14.13020.
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.
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.
Nationally, mean MPFS medical imaging spending per Medicare beneficiary was $207.17 ($95.71 [46.2%] to radiologists vs $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%).
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.
本文旨在研究与非放射科医生相比，医疗保险医师费用表（MPFS）对放射科医生的医学影像检查支付的区域差异。
使用 2011 年所有 Medicare 参保者的 5%随机样本，涵盖了约 250 万 B 部分受益人的数据，按州和美国人口普查局区域为所有 Medicare Berenson-Eggers 服务类型定义的医学影像服务计算了仅专业人员、仅技术人员和全球 MPFS 总支出。确定了放射科医生与非放射科医生的支付情况，并对差异进行了分析。
在全国范围内，每位 Medicare 受益人的平均 MPFS 医学影像支出为 207.17 美元（放射科医生为 95.71 美元，占 46.2%；非放射科医生为 111.46 美元，占 53.8%）。仅专业人员（通常为解释）支付中，有 20.6%支付给了非放射科医生。仅技术人员（通常为自有设备）支付中，有 84.9%支付给了非放射科医生。全球（专业和技术）支付中，有 70.1%支付给了非放射科医生。MPFS 医学影像支出中非放射科医生的比例范围从 32%（明尼苏达州）到 69.5%（南卡罗来纳州）。在 58.8%的州，MPFS 对非放射科医生的医学影像检查支付超过了对放射科医生的支付。在南部（58.5%），而非放射科医生获得的 MPFS 支付比例最高，在东北部（48.0%）则最低。
在全国范围内，53.8%的 MPFS 医学影像服务支付给了非放射科医生，他们在大多数以非解释性支付为主的州获得了大部分 MPFS 支付。在以非放射科医生为主体的医疗成像支付模式下，这种对非放射科医生的主要支出可能会对放射科服务的捆绑和统包支付模式产生影响。医学影像支付政策的制定必须考虑到所有提供者群体的角色以及相关的区域差异。
