Medical imaging has long been an attractive target for policymakers hoping to control the exploding growth of U.S. health care costs. But after enjoying torrid growth during the early 2000s, Medicare spending on imaging and utilization volumes have slowed down or contracted.

And a familiar bogeyman, the Deficit Reduction Act of 2005, probably shoulders some, but not all, of the blame, according to a bevy of studies presented last week at the Radiological Society of North America's annual meeting in Chicago.

Enter the DRA

Dr. Vijay M. Rao, a radiologist at Thomas Jefferson University in Philadelphia, whose team conducted most of the studies shared at a health policy session at RSNA, said one aim of the DRA was to curb self-referral - the practice by which doctors refer patients to receive scans on equipment they have a financial stake in. To do this, the act, which went into effect for imaging in January 2007, gutted Medicare technical component payments for equipment like MRIs, she explained.

"The thinking was if the technical payments were reduced substantially it would take out the profit margin and discourage (nonradiologist) physicians from buying their own equipment," Rao said at the session.

But according to her research, that's not what happened. Instead, nonradiolgoist doctors, like orthopedic surgeons, responded to the revenue shortfall by simply increasing volumes, she said.

Trawling the Medicare database

To do the research, Rao and her team at Thomas Jefferson combed through a massive Medicare database called the Medicare Part B Physician/Supplier Procedure Summary Files for the years 2000 through 2010. This database covers tens of millions of beneficiaries in the fee-for-service system, which involves the office-based procedures the DRA most affected.

For the paper Rao shared at RSNA, her team examined only MRI services, isolating them by selecting the appropriate codes. They then used provider codes to identify radiologists and orthopedic surgeons (as nonradiologist doctors who could self-refer), and place-of-service codes to narrow services down to office-based procedures. Next, they looked at only the global and technical component claims for the MRI services, as these are paid to the equipment owners.

Based on their data, they found for orthopedists, Medicare MRI utilization volume grew 21 percent in 2010 versus 2006, the year before the DRA took effect, she said. By contrast, in 2010, radiologists experienced an 8 percent drop in volume. Similarly, while payments fell by nearly 10 percent for orthopedists in 2010, they fell by one-third for radiologists.

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