Medicare payments to physicians attributable to noninvasive diagnostic imaging are down

The total amount of spending under the Medicare Physician Fee Schedule (PFS) attributable to noninvasive diagnostic imaging (NDI) is down, according to a new study published in the Journal of the American College of Radiology. Overall spending under the PFS, however, has increased.

For their analysis, the authors used Medicare Part B Physician/Supplier Procedure Summary Master Files data from 2003 to 2015. Medicare-approved spending under the PFS increased from more than $92 billion in 2003 to more than $132 billion in 2015. During that same timeframe, the portion of those payments attributable to NDI dropped from 9.5 percent to 6 percent, though it actually peaked at 10.8 percent in 2006.

The authors explained offered several reasons for this drop in payments attributable to NDI, including the Deficit Reduction Act of 2005, the multiple-procedure payment reduction, code bundling and more.

“The large decline seen in 2007 was due primarily to the Deficit Reduction Act, which took effect that year,” wrote David C. Levin, MD, department of radiology at Thomas Jefferson University Hospital in Philadelphia, and colleagues. “The decline in 2009 was largely due to code bundling in transthoracic echocardiography. The decline in 2010 was largely due to code bundling in radionuclide myocardial perfusion imaging, and the decline in 2011 was due in part to code bundling of CT of the abdomen and pelvis.”

Levin et al. added that the decrease continued after the code bundling of 2010 and 2011 due to “diminishing utilization rates and reimbursements.”

Breaking that total of 6 percent for 2015 down into provider categories, the authors found that radiologists received 3.2 percent of PFS payments attributable to NDI in 2015, cardiologists received 1.2 percent, all other physicians received 1.2 percent and “independent diagnostic testing facilities or multispecialty groups” made up the final 0.4 percent. All four of those provider categories followed the same trajectory, peaking in 2006 before decreasing after.

“The imaging community has at times come in for criticism over allegations of inappropriate use, overuse, and high cost,” the authors concluded. “Our purpose here has not been to confirm or deny those allegations. However, we believe that given the crucial role played by imaging in diagnosing so many of the most important diseases in this country, it is important for payers and policymakers to recognize that the proportion of payments made to physicians for imaging services has continuously decreased in recent years.”