1 Department of Radiology and Imaging Sciences, Emory University School of Medicine, 1364 Clifton Rd, NE, Ste D112, Atlanta, GA 30322.
2 Harvey L. Neiman Health Policy Institute, Reston, VA.
AJR Am J Roentgenol. 2018 Oct;211(4):827-830. doi: 10.2214/AJR.17.19438. Epub 2018 Jul 31.
Although most musculoskeletal MRI examinations are interpreted by radiologists, some nonradiologists provide interpretations as well. We aimed to study day of week (weekday vs weekend), site of service, and patient complexity differences between radiologists and nonradiologists interpreting lower extremity MRI examinations on Medicare beneficiaries.
Using fee-for-service carrier claims for a 5% sample of Medicare beneficiaries nationally from 2012 through 2014, we identified all lower extremity joint MRI examinations. Services were classified by physician specialty, day of week, and site of service. Charlson comorbidity index (CCI) values were calculated for all patients. Chi-square statistical testing was performed.
Of all 125,800 billed lower extremity joint MRI examinations, 118,295 (94.0%) were performed on weekdays and 7505 (6.0%) on weekends. Of the weekday examinations, radiologists interpreted 85,991 (83.3%) and nonradiologists 17,260 (16.7%). Of the weekend examinations, radiologists interpreted 6212 (92.8%) and nonradiologists 485 (7.2%). Of examinations performed in inpatient hospital and emergency department settings, radiologists interpreted 6499 (99.2%) and nonradiologists 51 (0.8%). Of the examinations on the most clinically complex patients (CCI ≥ 3), radiologists interpreted 4228 (90.2%) and nonradiologists 461 (9.8%). All interspecialty differences were statistically significant (p < 0.001).
In the Medicare population, radiologists interpret most lower extremity joint MRI examinations. Compared with nonradiologists, radiologists disproportionately provide services on weekends, in the highest acuity settings, and on the most clinically complex patients. To promote patient access and minimize disparities, future pay-for-performance metrics should consider temporal, acuity, and complexity parameters.
尽管大多数肌肉骨骼 MRI 检查由放射科医生解读，但也有一些非放射科医生提供解读。我们旨在研究 Medicare 受益人群中解读下肢 MRI 检查的放射科医生和非放射科医生之间在工作日（平日与周末）、服务地点和患者复杂性方面的差异。
我们使用了 2012 年至 2014 年全国 Medicare 受益人群的按费用支付的服务提供者索赔数据，对所有下肢关节 MRI 检查进行了识别。根据医生专业、服务地点和工作日对服务进行分类。为所有患者计算 Charlson 合并症指数（CCI）值。进行了卡方统计检验。
在所有 125800 次 billed 下肢关节 MRI 检查中，118295 次（94.0%）在工作日进行，7505 次（6.0%）在周末进行。在工作日的检查中，放射科医生解读了 85991 次（83.3%），非放射科医生解读了 17260 次（16.7%）。在周末的检查中，放射科医生解读了 6212 次（92.8%），非放射科医生解读了 485 次（7.2%）。在住院和急诊环境下进行的检查中，放射科医生解读了 6499 次（99.2%），非放射科医生解读了 51 次（0.8%）。在最具临床复杂性的患者（CCI≥3）的检查中，放射科医生解读了 4228 次（90.2%），非放射科医生解读了 461 次（9.8%）。所有专科之间的差异均具有统计学意义（p＜0.001）。
在 Medicare 人群中，放射科医生解读了大多数下肢关节 MRI 检查。与非放射科医生相比，放射科医生不成比例地在周末、最高急症环境下和最具临床复杂性的患者中提供服务。为了促进患者就诊并最大限度地减少差异，未来的按绩效付费指标应考虑时间、急症和复杂性参数。
