Showing papers by "Richard Duszak published in 2013"

Comparative analysis of Medicare spending for medical imaging: sustained dramatic slowdown compared with other services.

Abstract: OBJECTIVE. The purpose of this study was to assess trends in Medicare spending growth for medical imaging relative to other services and the Deficit Reduction Act (DRA). MATERIALS AND METHODS. We calculated per-beneficiary Part B Medicare medical imaging expenditures for three-digit Berenson-Eggers Type of Service (BETOS) categories using Physician Supplier Procedure Summary Master Files for 32 million beneficiaries from 2000 to 2011. We adjusted BETOS categories to address changes in coding and payment policy and excluded categories with 2011 aggregate spending less than $500 million. We computed and ranked compound annual growth rates over three periods: pre-DRA (2000–2005), DRA transition period (2005–2007), and post-DRA (2007–2011). RESULTS. Forty-four modified BETOS categories fulfilled the inclusion criteria. Between 2000 and 2006, Medicare outlays for nonimaging services grew by 6.8% versus 12.0% for imaging services. In the ensuing 5 years, annual growth in spending for nonimaging continued at 3.6...

Central Venous Access: Evolving Roles of Radiology and Other Specialties Nationally Over Two Decades

Abstract: Purpose The aim of this study was to evaluate national trends in central venous access (CVA) procedures over 2 decades with regard to changing specialty group roles and places of service. Methods Aggregated claims data for temporary central venous catheter and long-term CVA device (CVAD) procedures were extracted from Medicare Physician/Supplier Procedure Summary Master Files from 1992 through 2011. Central venous catheter and CVAD procedure volumes by specialty group and place of service were studied. Results Between 1992 and 2011, temporary and long-term CVA placement procedures increased from 638,703 to 808,071 (+27%) and from 76,444 to 316,042 (+313%), respectively. For temporary central venous catheters, radiology (from 0.4% in 1992 to 32.6% in 2011) now exceeds anesthesiology (from 37% to 22%) and surgery (from 30.4% to 11.7%) as the dominant provider group. Surgery continues to dominate in placement and explantation of long-term CVADs (from 80.7% to 50.4% and from 81.6% to 47.7%, respectively), but radiology's share has grown enormously (from 0.7% to 37.6% and from 0.2% to 28.6%). Although volumes remain small ( 100-fold growth for most services. The inpatient hospital remains the dominant site for temporary CVA procedures (90.0% in 1992 and 81.2% in 2011), but the placement of long-term CVADs has shifted from the inpatient (from 68.9% to 45.2%) to hospital outpatient (from 26.9% to 44.3%) setting. In all hospital settings combined, radiologists place approximately half of all tunneled catheters and three-quarters all peripherally inserted central catheters. Conclusions Over the past 2 decades, CVA procedures on Medicare beneficiaries have increased considerably. Radiology is now the dominant overall provider.

Trends in the utilization of medical imaging from 2003 to 2011: clinical encounters offer a complementary patient-centered focus.

Abstract: Purpose The aim of this study was to investigate trends in utilization and spending for medical imaging, using medical visits resulting in imaging as a novel metric of utilization. Methods Utilization and spending for medical imaging were examined using (1) Medicare Part B claims data from 2003 to 2011 to measure per-enrollee spending and (2) household component events data on the elderly Medicare-age population from the Medical Expenditure Panel Survey from 2003 to 2010 to measure utilization as a function of clinical encounters. Results Annual health spending and Medicare payments for imaging for the elderly population grew from $294 per enrollee in 2003 to $418 in 2006 and had declined to $390 by 2011. Over this entire time, however, annual medical visits by a similar Medicare-age (≥65 years old) population resulting in imaging trended consistently downward, from 12.8% in 2003 to 10.6% in 2011. Conclusions Despite early growth and then more recent declines in average Medicare spending per enrollee since 2003, the percentage of patient encounters resulting in medical imaging has significantly and consistently declined nationwide. Spending alone is thus an incomplete measure of changes in the role and utilization of medical imaging in overall patient care. As policymakers focus on medical imaging, a thoughtful analysis of payment policy influencing imaging utilization, and its role in concurrent and downstream patient care, will be critical to ensure appropriate patient access.

Medicare's Physician Quality Reporting System: early national radiologist experience and near-future performance projections

Abstract: Purpose The aim of this study was to examine radiologists' experiences during the first 4 years of Medicare's national physician pay-for-performance program and project near-future program outcomes for radiologists. Methods Medicare Physician Quality Reporting System (PQRS) program data from 2007 through 2010 were analyzed, focusing on outcomes and trends for radiologists. Tiered scenario modeling was used to project potential near-future radiologist outcomes as the program transitions from bonuses to penalties. Results Between 2007 and 2010, PQRS eligible, participating, and incentive-qualifying radiologists increased each year, from 28,899 to 44,026 (+52.3%), 6,237 to 16,770 (+168.9%), and 2,026 to 10,450 (+415.8%), respectively. Mean 2010 incentive bonuses ranged from $2,811.39 for diagnostic radiologists to $12,704.38 for radiation oncologists. Only 23.7% of eligible radiologists (10,450 of 44,026) qualified for incentives in 2010, but this compared favorably with 16.3% for nonradiologists (158,393 of 973,638) ( P Conclusions Only a minority of radiologists successfully qualified for incentives under PQRS, but that number has increased each year. Those using registry (rather than claims-based) reporting systems were more likely to receive bonuses. Physician and practice improvements in documentation and reporting, respectively, will be necessary to avert widespread near-future physician penalties.

Increased fluoroscopy time for central venous catheter placement by radiology residents versus staff radiologists.

Abstract: Purpose To evaluate differences in interventional radiology procedural fluoroscopy time (FT) for radiology residents versus staff radiologists, using central venous catheter (CVC) placement as an index service. Methods To minimize interservice and complexity variables, stand-alone temporary internal jugular CVC procedures were targeted for analysis. Reports and images from 1,067 temporary CVC services from 2 hospitals over 2 years were reviewed as part of a quality improvement initiative. Insertion site, catheter type (eg, smaller triple lumen versus larger hemodialysis), resident identifier, staff identifier, and documented FT were compiled and analyzed. Results Applying clinical (eg, concomitant venous angioplasty) and anatomic (eg, femoral access) exclusions, 537 cases with complete CVC procedure records were available for analysis. Radiology residents and staff radiologists were primary operators in 128 and 409 procedures, respectively. Distribution of resident procedures (82% right, 66% large lumen) was similar to that of staff (79% right, 63% large lumen). Mean FT of resident services was twice as long as that of staff services (1.24 minutes versus 0.63 minutes, P Conclusions When CVCs are placed by radiology residents, FT is double that for identical procedures performed by staff radiologists. Similar discrepancies likely exist for other interventional radiologic procedures. Residency training programs should initiate measures to monitor and manage fluoroscopy during interventional procedures to minimize radiation dose to patients, trainees, and other staff.

Professional Efficiencies for Diagnostic Imaging Services Rendered by Different Physicians: Analysis of Recent Medicare Multiple Procedure Payment Reduction Policy

Abstract: Purpose The aim of this study was to quantify potential physician work efficiencies and appropriate multiple procedure payment reductions for different same-session diagnostic imaging studies interpreted by different physicians in the same group practice. Methods Medicare Resource-Based Relative Value Scale data were analyzed to determine the relative contributions of various preservice, intraservice, and postservice physician diagnostic imaging work activities. An expert panel quantified potential duplications in professional work activities when separate examinations were performed during the same session by different physicians within the same group practice. Maximum potential work duplications for various imaging modalities were calculated and compared with those used as the basis of CMS payment policy. Results No potential intraservice work duplication was identified when different examination interpretations were rendered by different physicians in the same group practice. When multiple interpretations within the same modality were rendered by different physicians, maximum potential duplicated preservice and postservice activities ranged from 5% (radiography, fluoroscopy, and nuclear medicine) to 13.6% (CT). Maximum mean potential duplicated work relative value units ranged from 0.0049 (radiography and fluoroscopy) to 0.0413 (CT). This equates to overall potential total work reductions ranging from 1.39% (nuclear medicine) to 2.73% (CT). Across all modalities, this corresponds to maximum Medicare professional component physician fee reductions of 1.23 ± 0.38% (range, 0.95%-1.87%) for services within the same modality, much less than an order of magnitude smaller than those implemented by CMS. For services from different modalities, potential duplications were too small to quantify. Conclusions Although potential efficiencies exist in physician preservice and postservice work when same-session, same-modality imaging services are rendered by different physicians in the same group practice, these are relatively minuscule and have been grossly overestimated by current CMS payment policy. Greater transparency and methodologic rigor in government payment policy development are warranted.

The Erroneous Diagnosis of Prune Belly Syndrome in a Case of Posterior Urethral Valve

Abstract: Harris L. Cohen University of Tennessee, USA D Rubello Rovigo General Hospital in Veneto Italy Mehran Midia McMaster University Hospital, Canada John CS Cho Colorado Springs, CO USA E Yungjae Lee Children’s Hospital Boston, USA Shi Wei University of Alabama at Birmingham, USA Guiyang Hao UT Southwestern Medical Center at Dallas, USA Bruce I. Reiner Maryland Veterans Affairs Medical Center USA Radiology is a medical specialty that employs the use of imaging to both diagnose and treat disease visualized