Radiologists lose market share of Medicare ultrasound billings to cardiologists in some settings
Radiologists have lost a substantial share of the ultrasound billing market in certain sites of service over the last decade while cardiologists have gained ground, according to new research.
In the hospital outpatient setting between 2009 to 2021, cardiologists and cardiac surgeons saw the largest absolute increase under Medicare, leaping from 22% to 35.7%. At the same time, radiologists recorded the largest drop, falling from 60.8% to 50.5%, researchers wrote Wednesday in the American Journal of Roentgenology [1]. There was a similar shift on the inpatient side, with cardiologists and cardiac surgeons adding to their ultrasound market share (44.8% to 53%) while radiologists’ billings fell (39.4% to 34%).
“These shifts may reflect changes in relative utilization of specialty-specific examinations (e.g., abdominal ultrasound vs. echocardiography) or evolving payment policies favoring reimbursement in certain locations for particular examinations,” Casey E. Pelz, with the Harvey L. Neiman Health Policy Institute, and co-authors wrote Dec. 13.
For the study, experts analyzed Centers for Medicare & Medicaid Services physician/supplier procedure datasets spanning more than a decade. The database included all calendar-year, fee-for-service Medicare Part B claims nationwide from 2009 to 2021. Overall, the share of billed ultrasound services increased for radiologists (31.6% to 34.2%), cardiologists/cardiac surgeons (35% to 38.5%) and nonphysician practitioners (0.2% to 0.5%) during the study period. Meanwhile, primary care physicians (8.1% to 4.7%) and other physician types (22.4% to 19.6%) saw drops.
By place of service, the share of ultrasound billing increased in hospital outpatient settings (23.7% to 35.1%) and decreased in office (50.1% to 42.4%) and inpatient (25.1% to 21%) settings, the authors reported. Radiologists recorded the largest absolute increase in offices (14.1% to 21.6%) while PCPs sustained the biggest drop (12.5% to 8.1%). In other places of service, nonphysicians gained the largest share (up from 63.8% to 76.9%) while PCPs lost the most (13.7% to 2.1%).
“NPPs had high shares that increased over time in other places of service; such locations include assisted living and skilled nursing facilities, where the staff comprise a high proportion of nurses and other NPPs,” Pelz et al. wrote.
Read the rest of the research letter, including potential study limitations, in AJR at the link below.
Marty Stempniak has covered healthcare since 2012, with his byline appearing in the American Hospital Association's member magazine, Modern Healthcare and McKnight's. Prior to that, he wrote about village government and local business for his hometown newspaper in Oak Park, Illinois. He won a Peter Lisagor and Gold EXCEL awards in 2017 for his coverage of the opioid epidemic.