More than 28% of ED reads go uncompensated

More than 28 percent of services rendered by radiologists to emergency department (ED) patients were uncompensated to the tune of a mean $2,584 per month per radiologist, according to a study published in the Journal of the American College of Radiology.

Duszak et al note in their introduction that while overall imaging volumes are reportedly on the decline, the use of imaging, particularly CT, in the ED continues to rise, despite the higher costs of delivering care in that setting. This trend is apparent even in Massachusetts, the authors note, where early efforts at healthcare reform have dramatically reduced the number of uninsured.

The authors undertook the study using physician-identifier redacted administrative claims data from Zotec Partners, a major national billing company, consisting of 18,475,491 billing claims for services rendered in the ED setting by 2,935 radiologists in 40 states, from 2009 to 2012. Data use was restricted to that of those physicians who granted permission.

In addition to providing insight into the amount of uncompensated care, the study offers a snapshot of the type and frequency of studies performed in the ED. The most commonly rendered service was a single-view chest x-ray (15.8 percent), followed by a 2-view chest x-ray (12.3 percent); CT brain, without contrast (11.1 percent) was the third most commonly performed procedure.

The authors also performed a series of multivariate logistic regressions to determine the influence of additional factors in uncompensated care, including insurance status, imaging modality and year of service.

The modalities associated with the highest percentage of payment default were interventional radiology (35.8 percent), ultrasound (33.5 percent), CT (29.1 percent) and radiography (27.4 percent). Because it was the third most common study performed in the ED, CT accounted for the highest dollar value of uncompensated services per radiologist per month, at $1,633, or 65.1% of the total monthly burden of $2,584.

Slightly more than 16.1 percent of imaging services provided to insured patients in the ED were uncompensated; among uninsured patients, 94 percent of imaging services provided was uncompensated. Because insured patients accounted for the lion’s share of ED imaging, their unpaid bills added up to almost half (47.7 percent) of all uncompensated care in that setting.

In conclusion, the authors write that they expected most uncompensated care to be attributed to uninsured patients: “The fact that almost half of all uncompensated care was instead rendered by radiologists to patients with insurance was thus unexpected.”