Journal of the American College of Radiology : JACR最新文献

Purpose: To determine if relative Medicaid-to-Medicare reimbursement rates are associated with patient imaging utilization.

Methods: This cross-sectional study estimated the association of diagnostic imaging utilization with the state-level Medicaid-to-Medicare reimbursement ratio (MMRR) of professional payments. State-specific reimbursement ratios were computed for each imaging modality. Logistic regression was used to estimate the likelihood of having imaging, and gamma regression was used to estimate the average number of imaging studies for those with imaging. These models were performed for each gender-modality combination controlling for patient characteristics.

Results: Among 48,835,765 Medicaid patients, 54.3% were women. The median MMRR was 0.82 (interquartile range [IQR]: 0.73-0.94) for CT, 0.87 (IQR: 0.76-1.01) for MR, 0.76 (IQR: 0.69-0.99) for nuclear medicine (NM), 0.85 (IQR: 0.73-1.09) for ultrasound, and 0.82 (IQR: 0.74-0.97) for radiography or fluoroscopy (XR). The probability of having imaging was 25.9% for CT, 25.9% for MR, 21.4% for ultrasound, and 31.8% for XR higher at 75th percentile of the MMRR distribution compared with the 25th percentile (P < .001). For those with imaging, the mean number of imaging studies received was associated with 5.7% fewer studies for NM at the 75th percentile compared with the 25th percentile (P < .001), although there was no difference for other modalities.

Conclusions: Medicaid payments are related to imaging utilization. A higher MMRR is associated with a substantially increased likelihood of Medicaid patients receiving CT, MR, ultrasound, and XR imaging but no difference in the amount of imaging studies received for those with imaging for these modalities.

Purpose: Diagnostic imaging interpretations by nonphysician practitioners (NPPs) are increasing. With hospital-based imaging overwhelmingly interpreted by radiologists, we studied office-based interpretations by NPPs by their physician employer specialty.

Methods: Linking Medicare claims and provider datasets, we identified imaging interpretation claims submitted by nurse practitioners and physician assistants (together NPPs) in office settings, mapping NPPs to physician employer specialties, and assessed NPP characteristics and practice patterns.

Results: Between 2013 and 2022, the share of office-based imaging interpretations by NPPs increased 9.0% annually (from 2.52% to 5.47%) overall and by the following modalities: radiography (8.9%; 4.30%-9.23%), ultrasound (9.4%; 0.52%-1.18%), CT (9.4%; 0.13%-0.28%), MR (9.9%, 0.19%-0.44%), and nuclear medicine (7.2%; 0.07%-0.12%). Just 5.55% of NPPs rendered interpretations. NPPs employed by primary care physicians (PCPs) and orthopedists interpreted the largest shares of NPP imaging (39.5% and 34.1%, respectively). By modality, the largest shares by employer specialties were PCPs and orthopedists for radiography (39.7%, 37.4%), PCPs and practices without physicians for ultrasound (44.7%, 12.7%), PCPs and otolaryngologists for CT (58.2%, 17.1%), orthopedists and PCPs for MR (60.3%, 24.0%), and PCPs and cardiologists for nuclear medicine (40.4%, 25.9%). Younger NPPs (<35 years) interpreted imaging more frequently than older counterparts (≥65) (odds ratio 1.42 [95% confidence interval: 1.37-1.48]) and male NPPs interpreted imaging more frequently than female NPPs (odds ratio 1.61 [95% confidence interval: 1.58-1.63]). Overall interpretation shares ranged from 13.16% in Alaska to 0.29% in Washington, DC.

Conclusion: In Medicare, the share of office-based imaging interpretations performed by NPPs is increasing, varying considerably by state. Interpretations are performed by relatively few NPPs, particularly those younger, male, and employed by PCPs and orthopedists.