Medicare patients utilize more imaging in first half of year: What it could mean for practices

Utilization of Medicare imaging increases during the first half of a calendar year and if a patient has significant comorbidities, according to a Harvey L. Neiman Policy Institute study. The findings could impact Merit-based Incentive Payment System (MIPS) reporting strategies and risk-bearing reimbursement for imaging practices, the authors said.

Spotting a gap in previous Medicare utilization research, a group of researchers trawled CMS’s Chronic Conditions Data Warehouse to measure imaging utilization on a quarterly basis, analyzing data from 2008 to 2014. They observed a decrease in utilization by about 3.5 percent across the United States, with the largest decrease (4.7 percent) found in New England. Co-author Andrew B. Rosenkrantz, MD, an associate professor of radiology at NYU Langone Medical Center, offered an explanation.

“It is possible that once patients reach a coverage limit at some point during the year, they may postpone elective imaging during the remainder of the year, until the process restarts the following year,” he said, pointing to an earlier study that reached similar conclusions on care utilization in general (not just imaging).

While the retrospective analysis does not allow the authors to make a definitive claim on why the temporal disparity exists, they do believe that imaging practices should be aware—especially in the first year of MIPS reporting.

“One option for the initial 2017 reporting year is to submit data for only a 90-day period and still be eligible for a positive payment adjustment in 2019, though our study shows that imaging patterns can vary considerably within the course of a year,” said Rosenkrantz. “So it would make a lot of sense for practices to take such within-year variation into consideration when participating in any form of partial-year reporting option.”

This intra-year variation supports an annual review and negotiation of risk-based contracts and the reporting of quality measures rather than more narrow windows, the authors said.  

In addition, patients with significant co-morbidities or dual-eligibility showed significantly higher utilization of imaging, something practices should keep in mind when they engage in population-based contracting.

“it’s not the number of covered lives alone that matters, but rather the composition of the lives for which they are assuming risk,” said co-author Richard Duzak Jr, MD, professor at Emory University School of Medicine in Atlanta. “Whenever possible, radiology practices should seek to ascertain as much information as possible (such as age and comorbidities) about patient cohorts so that they can optimize the likelihood that such arrangements will be stable and financially sustainable.”

Imaging practices are not the only ones affected by the front-loading of imaging throughout a calendar year. Policy makers and other stakeholders should be aware of these disparities, ensuring that incentives and adjustments are properly aligned, according to Rosenkrantz.