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Frei AN, Gellad WF, Wertli MM, Haynes AG, Chiolero A, Rodondi N, Panczak R, Aujesky D. Trends and regional variation in vertebroplasty and kyphoplasty in Switzerland: a population-based small area analysis. Osteoporos Int 2021; 32:2515-2524. [PMID: 34156489 PMCID: PMC8608764 DOI: 10.1007/s00198-021-06026-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Accepted: 06/01/2021] [Indexed: 11/30/2022]
Abstract
UNLABELLED Regional variation in procedure use often reflects the uncertainty about the risks and benefit of procedures. In Switzerland, regional variation in vertebroplasty and balloon kyphoplasty rates was high, although the variation declined between 2013 and 2018. Substantial parts of the variation remained unexplained, and likely signal unequal access and differing physician opinion. PURPOSE To assess trends and regional variation in percutaneous vertebroplasty (VP) and balloon kyphoplasty (BKP) use across Switzerland. METHODS We conducted a population-based analysis using patient discharge data from all Swiss acute care hospitals for 2013-2018. We calculated age/sex-standardized mean procedure rates and measures of variation across VP/BKP-specific hospital areas (HSAs). We assessed the influence of potential determinants of variation using multilevel regression models with incremental adjustment for demographics, cultural/socioeconomic, health, and supply factors. RESULTS We analyzed 7855 discharges with VP/BKP from 31 HSAs. The mean age/sex-standardized procedure rate increased from 16 to 20/100,000 persons from 2013 to 2018. While the variation in procedure rates across HSAs declined, the overall variation remained high (systematic component of variation from 56.8 to 6.9 from 2013 to 2018). Determinants explained 52% of the variation. CONCLUSIONS VP/BKP procedure rates increased and regional variation across Switzerland declined but remained at a high level. A substantial part of the regional variation remained unexplained by potential determinants of variation.
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Affiliation(s)
- A N Frei
- Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
| | - W F Gellad
- Division of General Internal Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - M M Wertli
- Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - A G Haynes
- CTU Bern, University of Bern, Bern, Switzerland
| | - A Chiolero
- Population Health Laboratory, (#PopHealthLab), University of Fribourg, Fribourg, Switzerland
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Canada
| | - N Rodondi
- Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
| | - R Panczak
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - D Aujesky
- Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
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Cazzato RL, Bellone T, Scardapane M, De Marini P, Autrusseau PA, Auloge P, Garnon J, Jennings JW, Gangi A. Vertebral augmentation reduces the 12-month mortality and morbidity in patients with osteoporotic vertebral compression fractures. Eur Radiol 2021; 31:8246-8255. [PMID: 33899142 DOI: 10.1007/s00330-021-07985-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Revised: 02/26/2021] [Accepted: 04/02/2021] [Indexed: 12/14/2022]
Abstract
OBJECTIVES To investigate the 12-month all-cause mortality and morbidity in patients with osteoporotic vertebral compression fractures (OVCFs) undergoing vertebroplasty/balloon kyphoplasty (VP/BKP) versus non-surgical management (NSM). METHODS Following a Medline and EMBASE search for English language articles published from 2010 to 2019, 19 studies reporting on mortality and morbidity after VP/BKP in patients with OVCFs were selected. The 12-month timeline was set due to the largest amount of data availability at such time interval. Estimates for each study were reported as odds ratios (OR) along with 95% confidence intervals (CI) and p values. Fixed or random-effects meta-analyses were performed. All tests were based on a two-sided significance level of 0.05. RESULTS Pooled OR across 5 studies favored VP/BKP over NSM in terms of 12-month all-cause mortality (OR: 0.81 [95% CI: 0.46-1.42]; p = .46). Pooled OR across 11 studies favored VP/BKP over NSM in terms of 12-month all-cause morbidity (OR: 0.64 [95% CI: 0.31-1.30]; p = .25). Sub-analysis of data dealing with 12-month infective morbidity from any origin confirmed the benefit of VP/BKP over NSM (OR: 0.23 [95% CI, 0.02-2.54]; p = .23). CONCLUSION Compared to NSM, VP/BKP reduces the 12-month risk of all-cause mortality and morbidity by 19% and 36%, respectively. Moreover, VP/BKP reduces by 77% the 12-month risk of infection from any origin. KEY POINTS • Compared to non-surgical management, vertebral augmentation reduces the 12-month risk of all-cause mortality by 19% and all-cause morbidity by 36%. • Vertebral augmentation reduces the 12-month risk of infection morbidity from any origin by 77%.
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Affiliation(s)
- Roberto Luigi Cazzato
- Department of Interventional Radiology, University Hospital of Strasbourg, 1, place de l'hôpital, 67000, Strasbourg, France.
| | | | | | - Pierre De Marini
- Department of Interventional Radiology, University Hospital of Strasbourg, 1, place de l'hôpital, 67000, Strasbourg, France
| | - Pierre-Alexis Autrusseau
- Department of Interventional Radiology, University Hospital of Strasbourg, 1, place de l'hôpital, 67000, Strasbourg, France
| | - Pierre Auloge
- Department of Interventional Radiology, University Hospital of Strasbourg, 1, place de l'hôpital, 67000, Strasbourg, France
| | - Julien Garnon
- Department of Interventional Radiology, University Hospital of Strasbourg, 1, place de l'hôpital, 67000, Strasbourg, France
| | - Jack W Jennings
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO, USA
| | - Afshin Gangi
- Department of Interventional Radiology, University Hospital of Strasbourg, 1, place de l'hôpital, 67000, Strasbourg, France.,School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
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Hafezi-Nejad N, Bailey CR, Solomon AJ, Abou Areda M, Carrino JA, Khan M, Weiss CR. Vertebroplasty and kyphoplasty in the USA from 2004 to 2017: national inpatient trends, regional variations, associated diagnoses, and outcomes. J Neurointerv Surg 2020; 13:483-491. [PMID: 33334904 DOI: 10.1136/neurintsurg-2020-016733] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2020] [Revised: 10/12/2020] [Accepted: 10/14/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND To explore the national inpatient trends, regional variations, associated diagnoses, and outcomes of vertebral augmentation (vertebroplasty and kyphoplasty) in the USA from 2004 to 2017. METHODS Data from the National Inpatient Sample were used to study hospitalization records for percutaneous vertebroplasty and kyphoplasty. Longitudinal projections of trends and outcomes, including mortality, post-procedural complications, length of stay, disposition, and total hospital charges were analyzed. RESULTS Following a period of decreased utilization from 2008 to 2012, hospitalizations for vertebroplasty and kyphoplasty plateaued after 2013. Total hospital charges and overall financial burden of hospitalizations for vertebroplasty and kyphoplasty increased to a peak of $1.9 billion (range $1.7-$2.2 billion) in 2017. Overall, 8% of procedures were performed in patients with a history of malignancy. In multivariable modeling, lung cancer (adjusted OR (aOR) 2.6 (range 1.4-5.1)) and prostate cancer (aOR 3.4 (range 1.2-9.4)) were associated with a higher risk of mortality. The New England region had the lowest frequency of routine disposition (14.1±1.1%) and the lowest average hospital charges ($47 885±$1351). In contrast, 34.0±0.8% had routine disposition in the West Central South region, and average hospital charges were as high as $99 836±$2259 in the Pacific region. The Mountain region had the lowest number of procedures (5365±272) and the highest mortality rate (1.2±0.3%). CONCLUSION National inpatient trends of vertebroplasty and kyphoplasty utilization remained stable after a period of decline from 2008 to 2012, while the financial burden of hospitalizations increased. Despite recent improvements in outcomes, significant regional variations persisted across the USA.
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Affiliation(s)
- Nima Hafezi-Nejad
- Radiology, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | | | - Alex J Solomon
- Radiology, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | | | - John A Carrino
- Radiology and Imaging, Hospital for Special Surgery, New York, New York, USA
| | - Majid Khan
- Radiology, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Clifford R Weiss
- Radiology, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
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van Munster JJCM, Zamanipoor Najafabadi AH, de Boer NP, Peul WC, van den Hout WB, van Benthem PPG. Impact of surgical intervention trials on healthcare: A systematic review of assessment methods, healthcare outcomes, and determinants. PLoS One 2020; 15:e0233318. [PMID: 32442235 PMCID: PMC7244162 DOI: 10.1371/journal.pone.0233318] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Accepted: 05/01/2020] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Frameworks used in research impact evaluation studies vary widely and it remains unclear which methods are most appropriate for evaluating research impact in the field of surgical research. Therefore, we aimed to identify and review the methods used to assess the impact of surgical intervention trials on healthcare and to identify determinants for surgical impact. METHODS We searched journal databases up to March 10, 2020 for papers assessing the impact of surgical effectiveness trials on healthcare. Two researchers independently screened the papers for eligibility and performed a Risk of Bias assessment. Characteristics of both impact papers and trial papers were summarized. Univariate analyses were performed to identify determinants for finding research impact, which was defined as a change in healthcare practice. RESULTS Sixty-one impact assessments were performed in 37 included impact papers. Some surgical trial papers were evaluated in more than one impact paper, which provides a total of 38 evaluated trial papers. Most impact papers were published after 2010 (n = 29). Medical records (n = 10), administrative databases (n = 22), and physician's opinion through surveys (n = 5) were used for data collection. Those data were analyzed purely descriptively (n = 3), comparing data before and after publication (n = 29), or through time series analyses (n = 5). Significant healthcare impact was observed 49 times and more often in more recent publications. Having impact was positively associated with using medical records or administrative databases (ref.: surveys), a longer timeframe for impact evaluation and more months between the publication of the trial paper and the impact paper, data collection in North America (ref.: Europe), no economic evaluation of the intervention, finding no significant difference in surgical outcomes, and suggesting de-implementation in the original trial paper. CONCLUSIONS AND IMPLICATIONS Research impact evaluation receives growing interest, but still a small number of impact papers per year was identified. The analysis showed that characteristics of both surgical trial papers and impact papers were associated with finding research impact. We advise to collect data from either medical records or administrative databases, with an evaluation time frame of at least 4 years since trial publication.
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Affiliation(s)
- Juliëtte J. C. M. van Munster
- Department of Otorhinolaryngology and Head and Neck Surgery, Leiden University Medical Center (LUMC), Leiden University, Leiden, the Netherlands
- Leiden University Neurosurgical Center Holland (UNCH), LUMC and The Hague Medical Center (HMC), Leiden, the Netherlands
| | - Amir H. Zamanipoor Najafabadi
- Leiden University Neurosurgical Center Holland (UNCH), LUMC and The Hague Medical Center (HMC), Leiden, the Netherlands
| | - Nick P. de Boer
- Department of Otorhinolaryngology and Head and Neck Surgery, Leiden University Medical Center (LUMC), Leiden University, Leiden, the Netherlands
| | - Wilco C. Peul
- Leiden University Neurosurgical Center Holland (UNCH), LUMC and The Hague Medical Center (HMC), Leiden, the Netherlands
| | - Wilbert B. van den Hout
- Department of Biomedical Data Science–Medical Decision Making, Leiden University Medical Center, Leiden University, Leiden, the Netherlands
| | - Peter Paul G. van Benthem
- Department of Otorhinolaryngology and Head and Neck Surgery, Leiden University Medical Center (LUMC), Leiden University, Leiden, the Netherlands
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Hinde K, Maingard J, Hirsch JA, Phan K, Asadi H, Chandra RV. Mortality Outcomes of Vertebral Augmentation (Vertebroplasty and/or Balloon Kyphoplasty) for Osteoporotic Vertebral Compression Fractures: A Systematic Review and Meta-Analysis. Radiology 2020; 295:96-103. [PMID: 32068503 DOI: 10.1148/radiol.2020191294] [Citation(s) in RCA: 59] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Background Osteoporotic vertebral compression fractures (OVCFs) are prevalent, with associated morbidity and mortality. Vertebral augmentation (VA), defined as either vertebroplasty and/or balloon kyphoplasty (BKP), is a minimally invasive surgical treatment to reduce pain and further collapse and/or renew vertebral body height by introducing bone cement into fractured vertebrae. Nonsurgical management (NSM) for OVCF carries inherent risks. Purpose To summarize the literature and perform a meta-analysis on the mortality outcomes of patients with OVCF treated with VA compared with those in patients treated with NSM. Materials and Methods A single researcher performed a systematic literature review using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses, or PRISMA, guidelines. Online scientific databases were searched in April 2018 for English-language publications. Included studies investigated mortality in patients with OVCF with VA as the primary intervention and NSM as the comparator. A meta-analysis was performed for studies that reported hazard ratios (HRs) and 95% confidence intervals (CIs). HR was used as a summary statistic and was random-effect-models tested. The χ2 test was used to study heterogeneity between trials, and the I2 statistic was calculated to estimate variation across studies. Results Of the 16 included studies, eight reported mortality benefits in VA, seven reported no mortality difference, and one reported mixed results. Seven studies were included in a meta-analysis examining findings in more than 2 million patients with OVCF (VA = 382 070, NSM = 1 707 874). The pooled HR comparing VA to NSM was 0.78 (95% CI: 0.66, 0.92; P = .003), with mortality benefits across 2- and 5-year periods (HR = 0.70, 95% CI: 0.69, 0.71, P < .001; and HR = 0.79, 95% CI: 0.62, 0.9999, P = .05; respectively). Balloon kyphoplasty provided mortality benefits over vertebroplasty, with HRs of 0.77 (95% CI: 0.77, 0.78; P < .001) and 0.87 (95% CI: 0.87, 0.88; P < .001), respectively. Conclusion In a meta-analysis of more than 2 million patients, those with osteoporotic vertebral compression fractures who underwent vertebral augmentation were 22% less likely to die at up to 10 years after treatment than those who received nonsurgical treatment. © RSNA, 2020 See also the editorial by Jennings in this issue.
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Affiliation(s)
- Kenji Hinde
- From the Department of Radiology, Western Health, Western Hospital, Footscray, Melbourne, Victoria 3011, Australia (K.H.); Interventional Radiology Service-Department of Radiology, Austin Hospital, Melbourne, Australia (J.M., H.A.); Interventional Neuroradiology Service-Department of Radiology, Austin Hospital, Melbourne, Australia (J.M., H.A.); School of Medicine-Faculty of Health, Deakin University, Warrun Ponds, Australia (J.M., H.A.); Neuroendovascular Program, Massachusetts General Hospital, Harvard Medical School, Boston, Mass (J.A.H.); Stroke Division, Florey Institute of Neuroscience and Mental Health, University of Melbourne, Melbourne, Australia (H.A.); NeuroSpine Surgery Research Group, Prince of Wales Private Hospital, Sydney, Australia (K.P.); Interventional Neuroradiology Unit, Monash Imaging, Melbourne, Australia (J.M., H.A., R.V.C.); and School of Medicine, Monash University, Melbourne, Australia (R.V.C.)
| | - Julian Maingard
- From the Department of Radiology, Western Health, Western Hospital, Footscray, Melbourne, Victoria 3011, Australia (K.H.); Interventional Radiology Service-Department of Radiology, Austin Hospital, Melbourne, Australia (J.M., H.A.); Interventional Neuroradiology Service-Department of Radiology, Austin Hospital, Melbourne, Australia (J.M., H.A.); School of Medicine-Faculty of Health, Deakin University, Warrun Ponds, Australia (J.M., H.A.); Neuroendovascular Program, Massachusetts General Hospital, Harvard Medical School, Boston, Mass (J.A.H.); Stroke Division, Florey Institute of Neuroscience and Mental Health, University of Melbourne, Melbourne, Australia (H.A.); NeuroSpine Surgery Research Group, Prince of Wales Private Hospital, Sydney, Australia (K.P.); Interventional Neuroradiology Unit, Monash Imaging, Melbourne, Australia (J.M., H.A., R.V.C.); and School of Medicine, Monash University, Melbourne, Australia (R.V.C.)
| | - Joshua A Hirsch
- From the Department of Radiology, Western Health, Western Hospital, Footscray, Melbourne, Victoria 3011, Australia (K.H.); Interventional Radiology Service-Department of Radiology, Austin Hospital, Melbourne, Australia (J.M., H.A.); Interventional Neuroradiology Service-Department of Radiology, Austin Hospital, Melbourne, Australia (J.M., H.A.); School of Medicine-Faculty of Health, Deakin University, Warrun Ponds, Australia (J.M., H.A.); Neuroendovascular Program, Massachusetts General Hospital, Harvard Medical School, Boston, Mass (J.A.H.); Stroke Division, Florey Institute of Neuroscience and Mental Health, University of Melbourne, Melbourne, Australia (H.A.); NeuroSpine Surgery Research Group, Prince of Wales Private Hospital, Sydney, Australia (K.P.); Interventional Neuroradiology Unit, Monash Imaging, Melbourne, Australia (J.M., H.A., R.V.C.); and School of Medicine, Monash University, Melbourne, Australia (R.V.C.)
| | - Kevin Phan
- From the Department of Radiology, Western Health, Western Hospital, Footscray, Melbourne, Victoria 3011, Australia (K.H.); Interventional Radiology Service-Department of Radiology, Austin Hospital, Melbourne, Australia (J.M., H.A.); Interventional Neuroradiology Service-Department of Radiology, Austin Hospital, Melbourne, Australia (J.M., H.A.); School of Medicine-Faculty of Health, Deakin University, Warrun Ponds, Australia (J.M., H.A.); Neuroendovascular Program, Massachusetts General Hospital, Harvard Medical School, Boston, Mass (J.A.H.); Stroke Division, Florey Institute of Neuroscience and Mental Health, University of Melbourne, Melbourne, Australia (H.A.); NeuroSpine Surgery Research Group, Prince of Wales Private Hospital, Sydney, Australia (K.P.); Interventional Neuroradiology Unit, Monash Imaging, Melbourne, Australia (J.M., H.A., R.V.C.); and School of Medicine, Monash University, Melbourne, Australia (R.V.C.)
| | - Hamed Asadi
- From the Department of Radiology, Western Health, Western Hospital, Footscray, Melbourne, Victoria 3011, Australia (K.H.); Interventional Radiology Service-Department of Radiology, Austin Hospital, Melbourne, Australia (J.M., H.A.); Interventional Neuroradiology Service-Department of Radiology, Austin Hospital, Melbourne, Australia (J.M., H.A.); School of Medicine-Faculty of Health, Deakin University, Warrun Ponds, Australia (J.M., H.A.); Neuroendovascular Program, Massachusetts General Hospital, Harvard Medical School, Boston, Mass (J.A.H.); Stroke Division, Florey Institute of Neuroscience and Mental Health, University of Melbourne, Melbourne, Australia (H.A.); NeuroSpine Surgery Research Group, Prince of Wales Private Hospital, Sydney, Australia (K.P.); Interventional Neuroradiology Unit, Monash Imaging, Melbourne, Australia (J.M., H.A., R.V.C.); and School of Medicine, Monash University, Melbourne, Australia (R.V.C.)
| | - Ronil V Chandra
- From the Department of Radiology, Western Health, Western Hospital, Footscray, Melbourne, Victoria 3011, Australia (K.H.); Interventional Radiology Service-Department of Radiology, Austin Hospital, Melbourne, Australia (J.M., H.A.); Interventional Neuroradiology Service-Department of Radiology, Austin Hospital, Melbourne, Australia (J.M., H.A.); School of Medicine-Faculty of Health, Deakin University, Warrun Ponds, Australia (J.M., H.A.); Neuroendovascular Program, Massachusetts General Hospital, Harvard Medical School, Boston, Mass (J.A.H.); Stroke Division, Florey Institute of Neuroscience and Mental Health, University of Melbourne, Melbourne, Australia (H.A.); NeuroSpine Surgery Research Group, Prince of Wales Private Hospital, Sydney, Australia (K.P.); Interventional Neuroradiology Unit, Monash Imaging, Melbourne, Australia (J.M., H.A., R.V.C.); and School of Medicine, Monash University, Melbourne, Australia (R.V.C.)
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Degnan AJ, Yi PH, Kim N, Swietlik J, Huh E, Nguyen JC. Diagnostic and Interventional Imaging Services are Significant Sources of Medicare Revenue for Highly Reimbursed Nonradiologist Providers. Curr Probl Diagn Radiol 2018; 49:17-22. [PMID: 30466795 DOI: 10.1067/j.cpradiol.2018.10.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Revised: 10/28/2018] [Accepted: 10/29/2018] [Indexed: 11/22/2022]
Abstract
INTRODUCTION Nonradiologist providers increasingly perform diagnostic imaging examinations and imaging-guided interventions traditionally performed by radiologists, which have raised concerns regarding appropriate utilization and self-referral. The purpose of this study was to assess the contribution of imaging studies to Medicare reimbursements for highly compensated nonradiologist providers in specialties often performing imaging studies. METHODS The Medicare Provider Utilization and Payment Database was queried for provider information regarding overall reimbursement for providers in anesthesiology, cardiology, emergency medicine, neurology, obstetrics and gynecology, orthopedic surgery, neurology, and vascular surgery. Information regarding imaging studies reported and payment amounts were extracted for the 25 highest-reimbursed providers. Data were analyzed for relative contribution of imaging payments to overall medical Medicare payments. RESULTS Significant differences between numbers of imaging studies, types of imaging, and payment amounts were noted based on provider specialty (p < 0.001). Highest-reimbursed cardiologists received the greatest percentage of Medicare payments from imaging (18.3%) followed by vascular surgery (11.6%), obstetrics and gynecology (10.9%), orthopedic surgery (9.6%), emergency medicine (8.7%), neurology (7.8%), and anesthesiology (3.2%) providers. Mean imaging payments amongst highly reimbursed nonradiologists were greatest for cardiology ($578,265), vascular surgery ($363,912), and orthopedic surgery ($113,634). Amongst highly reimbursed specialists, most common nonradiologist imaging payments were from ultrasound (45%) and cardiac nuclear medicine studies (40%). CONCLUSIONS Nonradiologist performed imaging payments comprised substantial proportions of overall Medicare reimbursement for highly reimbursed physicians in several specialties, especially cardiology, vascular surgery, and orthopedic surgery. Further investigation is needed to better understand the wider economic implications of nonradiologist imaging study performance and self-referral beyond the Medicare population.
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Affiliation(s)
- Andrew J Degnan
- Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, PA.; Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA.
| | - Paul H Yi
- The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Nathan Kim
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - John Swietlik
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Eric Huh
- The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Jie C Nguyen
- Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, PA.; Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
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