The Disproportionate Effects of the Deficit Reduction Act of 2005 on Radiologists' Private Office MRI and CT Practices Compared With Those of Other Physicians

doi:10.1016/j.jacr.2009.05.010

Journal of the American College of Radiology

Volume 6, Issue 9, September 2009, Pages 620-625

https://doi.org/10.1016/j.jacr.2009.05.010 Get rights and content

Purpose

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.

Materials and Methods

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.

Results

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.

Conclusion

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.

Section snippets

Materials and Methods

We used the Medicare Part B Physician/Supplier Procedure Summary Master Files (PSPSMFs) for 2002 through 2007. These files cover the nearly 37 million beneficiaries who are enrolled in the traditional Medicare fee-for-service program. They provide information on all procedure codes in the Current Procedural Terminology^®, fourth edition, manual. For each code each year, the files show the number of procedures performed, Part B payments made, the specialties of the physician providers, and other

Results

The Medicare office MRI volume trends among radiologists, all other nonradiologist physicians as a group, and IDTFs are shown in Table 1. Between 2002 and 2006, radiologists' MRI compound annual volume growth rate in offices was 8.4%, compared with 24.8% among nonradiologist physicians. During 2007, the first year the DRA was in effect, MRI office volume dropped by 2.0% among radiologists, but it increased by 7.6% among nonradiologist physicians. The corresponding payment data are shown in

Discussion

The data in Table 1, Table 2, Table 3, Table 4 indicate that radiologists perform the majority of in-office MRI and CT scans and receive the majority of the Medicare Part B payments for them. However, between 2002 and 2006, the annual volume growth rates in both modalities among nonradiologist physicians were almost triple those among radiologists. Annual payment growth rates among nonradiologists were more than double those among radiologists.

The year 2007, the first year in which the DRA was

References (5)

D.C. Levin et al.
Ownership or leasing of MRI facilities by nonradiologist physicians is a rapidly growing trend
J Am Coll Radiol
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D.C. Levin et al.
Ownership or leasing of CT scanners by nonradiologist physicians—a rapidly growing trend that raises concerns about self-referral
J Am Coll Radiol
(2008)

There are more references available in the full text version of this article.

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: This study was supported in part by a grant from the American College of Radiology (Reston, Va).

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Original articleThe Disproportionate Effects of the Deficit Reduction Act of 2005 on Radiologists' Private Office MRI and CT Practices Compared With Those of Other Physicians

Purpose

Materials and Methods

Results

Conclusion

Section snippets

Materials and Methods

Results

Discussion

J Am Coll Radiol

J Am Coll Radiol

Original article
The Disproportionate Effects of the Deficit Reduction Act of 2005 on Radiologists' Private Office MRI and CT Practices Compared With Those of Other Physicians