More Medicare Payments for Noninvasive Imaging May Go to Nonradiologists vs Radiologists

Steven Fox

January 06, 2011

January 6, 2011 — Nonradiologist physicians are now paid more by Medicare for noninvasive diagnostic imaging (NDI) than are radiologists, according to a study that appears in the January 2011 issue of the Journal of the American College of Radiology.

"Radiologists have always been considered the physicians who 'control' ...NDI and are primarily responsible for its growth," write lead author David Levin, MD, professor emeritus and former chair of the Department of Radiology at Thomas Jefferson University Hospital, in Philadelphia, Pennsylvania, and colleagues. "Yet nonradiologists have become increasingly aggressive in their performance and interpretation of imaging."

To find out how actual Medicare dollars for NDIs are allocated, the study authors used Medicare Part B files to track overall payments to radiologists and nonradiologists from 1998 to 2008.

In 1998, payments to radiologists for NDIs were $2.563 billion, 27% higher than the $2.020 billion that went to nonradiologists, the researchers report. However, from 1998 to 2006, Medicare payments to nonradiologists increased by 166% vs 107% to radiologists. By 2006, nonradiologists were receiving more total payments than radiologists.

At the beginning of 2007, the Deficit Reduction Act of 2005 went into effect. The law, passed by Congress, was aimed at reining in Medicare and other government spending. By 2008, payments to radiologists had been cut by 13%, and nonradiologists took an 11% loss.

In an email to Medscape Medical News, Dr. Levin said he believes a substantial reason nonradiologists have made greater gains than radiologists is self-referral. "Self-referral in imaging among nonradiologist physicians has gotten to be a big business," he said. The Deficit Reduction Act cut reimbursements for private office high-tech imaging quite sharply. "But our data show that it hasn't really put a dent in self-referrals." Nonradiologist doctors who have their own MRI [magnetic resonance imaging] or CT [computed tomography] scanners can make up for any revenue shortfalls by simply referring more of their patients to themselves for additional scanning, he said.

Dr. Levin concluded, "It just proves the point that if they continue to allow self-referral to go on without any controls, imaging costs are going to skyrocket."

This study was supported in part by a grant from the American College of Radiology (Reston, Virginia). The study authors have disclosed no relevant financial relationships.

J Am Coll Radiol. 2011;8:26-32. Abstract

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