Use of Public Data to Target Variation in Providers’ Use of CT and MR Imaging among Medicare Beneficiaries
Abstract
Using public data, we can better identify potential geographic and procedure targets for improving providers’ use of diagnostic CT and MR imaging.
Purpose
To examine geographic variation in providers’ use of diagnostic imaging to identify potential targets for quality improvement initiatives after adjusting for imaging referral across hospital referral regions (HRRs).
Materials and Methods
Using two Centers for Medicare and Medicaid Services datasets, the authors included all claims for beneficiaries enrolled in the Medicare fee-for-service program. Diagnostic imaging procedures were selected on the basis of common procedure coding system codes, excluding interventional procedures. The authors assessed providers’ use of imaging for each HRR after creating an imaging referral index (IRI) to adjust for imaging referral rates across HRRs. Relative risk statistics were used to assess geographic variation. The authors calculated two imaging measures for computed tomography (CT) and magnetic resonance (MR) imaging: IRI-adjusted utilization intensity (number of examinations per 1000 beneficiaries) and total payments (in dollars, after deducting deductibles and coinsurances) in each HRR. High-impact regions were defined as those in the highest deciles for both imaging intensity and payment.
Results
For 34 million Medicare beneficiaries, 124 million unique diagnostic imaging services (totaling $5.6 billion) were performed in 2012. The average adjusted CT utilization intensity ranged from 330.4 studies per 1000 beneficiaries in the lowest decile to 684.0 in the highest decile (relative risk, 2.1); adjusted MR imaging utilization intensity varied from 105.7 studies per 1000 beneficiaries to 256.3 (relative risk, 2.4). The most common CT and MR imaging procedures were head CT and lumbar spine MR imaging.
Conclusion
With use of public data, the authors identified a wide variation in imaging use across the United States. Potential targets for future imaging quality improvement initiatives include head CT and lumbar spine MR imaging.
© RSNA, 2015
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Article History
Received August 15, 2014; revision requested October 1; revision received November 3; final version accepted December 9.Published online: Feb 05 2015
Published in print: June 2015