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Chartrand N, Stecher C, Rajendra S, Rosenkrantz AB, Duszak R, Hughes DR. An Examination of Racial and Ethnic Disparities in the Use of Prostate Biopsy and Magnetic Resonance Imaging in Prostate Cancer Screening. Urol Pract 2023; 10:612-619. [PMID: 37498656 DOI: 10.1097/upj.0000000000000435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Accepted: 06/30/2023] [Indexed: 07/28/2023]
Abstract
INTRODUCTION We assessed racial and ethnic disparities in the use of prostate biopsy or MRI following an elevated PSA result. METHODS We retrospectively evaluated insurance claims from Optum's de-identified Clinformatics Data Mart database from January 1, 2011 to December 31, 2017. This was a large commercially insured cohort from across the United States. We included all male enrollees over 40 years old receiving an elevated PSA result with no prior prostate biopsy or MRI and no confirmed urinary tract infection within 6 weeks of PSA test. RESULTS A total of 765,409 participants met inclusion criteria with 43,711 (5.71%) receiving a PSA result above 4 ng/mL. Of these, 7,399 received either a prostate biopsy or MRI within 180 days. Men between ages 40-54 (29.48%) were most likely to receive prostate biopsy or MRI after an elevated PSA, followed by those between 55-64 (24.91%), 65-74 (18.56%), 75-84 (6.33%), and above 85 (3.62%). Compared to White patients, Black patients were more likely to receive either a prostate biopsy or MRI (OR: 1.16, 95% CI: 1.01, 1.32) following an elevated PSA level, while Asian (OR: 0.72, 95% CI: 0.54, 0.96) and Hispanic (OR: 0.83, 95% CI: 0.70, 0/97) patients were less likely. CONCLUSIONS Physicians appear to be following the reported statistical incidence of prostate cancer by race and ethnicity when using prostate biopsy or MRI for patients with elevated PSA levels. These results demonstrate the importance of publishing statistical data on disease incidence by race and ethnicity for informing physicians' decision-making.
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Affiliation(s)
| | - Chad Stecher
- College of Health Solutions, Arizona State University, Phoenix, Arizona
| | - Shubhsri Rajendra
- School of Economics, Georgia Institute of Technology, Atlanta, Georgia
| | | | - Richard Duszak
- Department Radiology, University of Mississippi Medical Center, Jackson, Mississippi
| | - Danny R Hughes
- College of Health Solutions, Arizona State University, Phoenix, Arizona
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Triana BP, Chari T, Muench D, Colglazier R, Vinson E, Willhite J, Kim CY, Martin JG, Hemingway J, Hughes DR, Rosman D, Duszak R, French R. Financial Impact of Imaging Examination Site of Service in the Medicare Population. Curr Probl Diagn Radiol 2023; 52:522-527. [PMID: 37718184 DOI: 10.1067/j.cpradiol.2023.08.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Accepted: 08/23/2023] [Indexed: 09/19/2023]
Abstract
PURPOSE The financial sustainability of the US healthcare system is a growing concern in an environment of declining reimbursement and rising costs. Variable Centers for Medicare and Medicaid (CMS) reimbursement and denial rates for specific imaging examinations exist across sites of service, adding complexity to financial planning for healthcare organizations. Understanding the financial implications of site of service in existing CMS reimbursement for imaging may be of strategic importance for organizations going forward. MATERIALS AND METHODS Current Procedural Terminology (CPT) codes were obtained for common cross-sectional imaging examinations using the 2022 CMS Medicare Physician Fee Schedule. Using reimbursement rates with historical volumes and denial rates, a simulation was created to estimate the overall reimbursement of paired hospital outpatient departments (HOPD) and free-standing office (FSO) sites. A baseline simulation was performed with random allocation of imaging examinations between sites of service, and an optimized simulation was performed to estimate the maximum financial impact of targeted allocation between sites. These simulations were performed for paired CT and MR scanners separately. RESULTS For CT, the baseline simulation estimated annual average reimbursement for combined HOPD and FSO was $3.25M. Reimbursement increased to $3.51M after optimized reallocation of studies between sites of service, resulting in an expected gain of $260,162 for a set of paired HOPD and FSO scanners. For MR, the same approach resulted in baseline reimbursement of $2.51M, increasing to $2.60M upon reallocation between sites for an expected gain of $87,532. Assuming a stable cost of service delivery, this approach would result in improved margins of 8% for CT and 3.5% for MR. There were 28 CT and 19 MRI daily patient imaging appointments at each respective HOPD and FSO scanners, unchanged between baseline and optimized cases. Differences in reimbursement rates between sites were the dominant driver of increased margins at low denial rates, although denial rates became dominant at values greater than 50%. CONCLUSION Given CMS payment and denial rate variability, optimally allocating imaging studies between sites of service may improve reimbursement for the same services delivered. Although financial incentives exist for site allocation, such decisions should require physician input to assess safety and appropriate level of care. This work contributes to an understanding of financial incentives of existing reimbursement policy and may guide future policy design towards high value care.
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Affiliation(s)
- Brian P Triana
- Department of Radiology, Duke University Medical Center, Durham, NC.
| | | | - Dylan Muench
- Duke University Fuqua School of Business, Durham, NC
| | - Roy Colglazier
- Department of Radiology, Duke University Medical Center, Durham, NC
| | - Emily Vinson
- Department of Radiology, Duke University Medical Center, Durham, NC
| | - Jay Willhite
- Department of Radiology, Duke University Medical Center, Durham, NC
| | - Charles Y Kim
- Department of Radiology, Duke University Medical Center, Durham, NC
| | - Jon G Martin
- Department of Radiology, Duke University Medical Center, Durham, NC
| | | | - Danny R Hughes
- College of Health Solutions, Arizona State University, Phoenix, AZ
| | - David Rosman
- Department of Radiology, Massachusetts General Hospital, Boston, MA
| | - Richard Duszak
- Department of Radiology, University of Mississippi Medical Center, Jackson, MS
| | - Robert French
- Department of Radiology, Duke University Medical Center, Durham, NC
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Chartrand N, Stecher C, Rajendra S, Rosenkrantz AB, Duszak R, Hughes DR. Reply by Authors. Urol Pract 2023; 10:620. [PMID: 37753965 DOI: 10.1097/upj.0000000000000435.02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Accepted: 06/30/2023] [Indexed: 09/28/2023]
Affiliation(s)
| | - Chad Stecher
- College of Health Solutions, Arizona State University, Phoenix, Arizona
| | - Shubhsri Rajendra
- School of Economics, Georgia Institute of Technology, Atlanta, Georgia
| | | | - Richard Duszak
- Department Radiology, University of Mississippi Medical Center, Jackson, Mississippi
| | - Danny R Hughes
- College of Health Solutions, Arizona State University, Phoenix, Arizona
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Hughes DR, Chen J, Wallace AE, Rajendra S, Santavicca S, Duszak R, Rula EY, Smith RA. Comparison of Lung Cancer Screening Eligibility and Use between Commercial, Medicare, and Medicare Advantage Enrollees. J Am Coll Radiol 2023; 20:402-410. [PMID: 37001939 DOI: 10.1016/j.jacr.2022.12.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Revised: 12/16/2022] [Accepted: 12/23/2022] [Indexed: 03/31/2023]
Abstract
OBJECTIVE Lung cancer screening does not require patient cost-sharing for insured people in the U.S. Little is known about whether other factors associated with patient selection into different insurance plans affect screening rates. We examined screening rates for enrollees in commercial, Medicare Fee-for-Service (FFS), and Medicare Advantage plans. METHODS County-level smoking rates from the 2017 County Health Rankings were used to estimate the number of enrollees eligible for lung cancer screening in two large retrospective claims databases covering: a 5% national sample of Medicare FFS enrollees; and 100% sample of enrollees associated with large commercial and Medicare Advantage carriers. Screening rates were estimated using observed claims, stratified by payer, before aggregation into national estimates by payer and demographics. Chi-square tests were used to examine differences in screening rates between payers. RESULTS There were 1,077,142 enrollees estimated to be eligible for screening. The overall estimated screening rate for enrollees by payer was 1.75% for commercial plans, 3.37% for Medicare FFS, and 4.56% for Medicare Advantage plans. Screening rates were estimated to be lowest among females (1.55%-4.02%), those aged 75-77 years (0.63%-2.87%), those residing in rural areas (1.88%-3.56%), and those in the West (1.16%-3.65%). Among Medicare FFS enrollees, screening rates by race/ethnicity were non-Hispanic White (3.71%), non-Hispanic Black (2.17%) and Other (1.68%). CONCLUSIONS Considerable variation exists in lung cancer screening between different payers and across patient characteristics. Efforts targeting historically vulnerable populations could present opportunities to increase screening.
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Affiliation(s)
- Danny R Hughes
- Director, Health Economics and Analytics Lab, School of Economics, Georgia Institute of Technology, Atlanta, Georgia; Department of Radiology and Imaging Sciences, Emory University, Atlanta, Georgia; and College of Health Solutions, Arizona State University, Phoenix, Arizona.
| | - Jie Chen
- Department of Health Professions, James Madison University, Harrisonburg, Virginia
| | | | - Shubhrsi Rajendra
- School of Economics, Georgia Institute of Technology, Atlanta, Georgia
| | | | - Richard Duszak
- Chair, Department of Radiology, University of Mississippi Medical Center, Jackson, Mississippi; and Chair, Commission on Leadership and Practice Development, American College of Radiology. https://twitter.com/RichDuszak
| | - Elizabeth Y Rula
- Executive Director, Harvey L. Neiman Health Policy Institute, Reston, Virginia
| | - Robert A Smith
- Senior Vice President, Early Cancer Detection Science, American Cancer Society, Atlanta, Georgia
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Jayaraman K, Santavicca S, Hughes DR, Hirsch JA, Duszak R, Chatterjee AR. Recent trends in high-volume Medicare stroke thrombectomy provider characteristics. J Neurointerv Surg 2023; 15:399-401. [PMID: 35210330 DOI: 10.1136/neurintsurg-2021-018611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Accepted: 02/03/2022] [Indexed: 11/03/2022]
Abstract
BACKGROUND Intracranial mechanical thrombectomy (MT) is increasingly indicated for use in acute ischemic stroke patients. We analyzed recent trends in the characteristics and geographic distributions of physicians providing this service with frequency to Medicare beneficiaries. METHODS We linked public data sources to elucidate and visualize trends in high-volume MT providers between 2016 and 2019. RESULTS High-volume MT providers increased by 184% between 2016 and 2019. The number of neurosurgeons, neurologists, and radiologists in this physician population increased by 251%, 205%, and 139%, respectively. Male practitioners accounted for 96% of providers in the most recent year of analysis. International medical graduates accounted for roughly one-third of these physicians across all 4 years of analysis. As of 2019, the three states with the most high-volume MT providers were Florida, California, and Texas, accounting for 7%, 7%, and 6% of providers, respectively. CONCLUSIONS High-volume providers of MT services for Medicare beneficiaries represent a dynamic and rapidly expanding subset of physicians with diverse specialty backgrounds.
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Affiliation(s)
- Keshav Jayaraman
- Mallinckrodt Institute of Radiology, Department of Neurosurgery and Department of Neurology, Washington University in St Louis School of Medicine, St Louis, Missouri, USA
| | - Stefan Santavicca
- Radiology and Imaging Sciences, Emory University, Atlanta, Georgia, USA
| | - Danny R Hughes
- Radiology and Imaging Sciences, Emory University, Atlanta, Georgia, USA.,School of Economics, Georgia Institute of Technology, Atlanta, Georgia, USA
| | | | - Richard Duszak
- Radiology and Imaging Sciences, Emory University, Atlanta, Georgia, USA
| | - Arindam R Chatterjee
- Mallinckrodt Institute of Radiology, Department of Neurosurgery and Department of Neurology, Washington University in St Louis School of Medicine, St Louis, Missouri, USA
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Hughes DR, Espinoza W, Fein S, Rula EY, McGinty G. Patient Cost-Sharing and Utilization of Breast Cancer Diagnostic Imaging by Patients Undergoing Subsequent Testing After a Screening Mammogram. JAMA Netw Open 2023; 6:e234893. [PMID: 36972047 PMCID: PMC10043745 DOI: 10.1001/jamanetworkopen.2023.4893] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/29/2023] Open
Abstract
Importance Out-of-pocket costs (OOPCs) have been largely eliminated for screening mammography. However, patients still face OOPCs when undergoing subsequent diagnostic tests after the initial screening, which represents a potential barrier to those who require follow-up testing after initial testing. Objective To examine the association between the degree of patient cost-sharing and the use of diagnostic breast cancer imaging after undergoing a screening mammogram. Design, Setting, and Participants This retrospective cohort study used medical claims from Optum's deidentified Clinformatics Data Mart Database, a commercial claims database derived from a database of administrative health claims for members of large commercial and Medicare Advantage health plans. The large commercially insured cohort included female patients aged 40 years or older with no prior history of breast cancer undergoing a screening mammogram examination. Data were collected from January 1, 2015, to December 31, 2017, and analysis was conducted from January 2021 to September 2022. Exposures A k-means clustering machine learning algorithm was used to classify patient insurance plans by dominant cost-sharing mechanism. Plan types were then ranked by OOPCs. Main Outcomes and Measures A multivariable 2-part hurdle regression model was used to examine the association between patient OOPCs and the number and type of diagnostic breast services undergone by patients observed to undergo subsequent testing. Results In our sample, 230 845 women (220 023 [95.3%] aged 40 to 64 years; 16 810 [7.3%] Black, 16 398 [7.1%] Hispanic, and 164 702 [71.3%] White) underwent a screening mammogram in 2016. These patients were covered by 22 828 distinct insurance plans associated with 6 025 741 enrollees and 44 911 473 distinct medical claims. Plans dominated by coinsurance were found to have the lowest mean (SD) OOPCs ($945 [$1456]), followed by balanced plans ($1017 [$1386]), plans dominated by copays ($1020 [$1408]), and plans dominated by deductibles ($1186 [$1522]). Women underwent significantly fewer subsequent breast imaging procedures in dominantly copay (24 [95% CI, 11-37] procedures per 1000 women) and dominantly deductible (16 [95% CI, 5-28] procedures per 1000 women) plans compared with coinsurance plans. Patients from all plan types underwent fewer breast magnetic resonance imaging (MRI) scans than patients in the lowest OOPC plan (balanced, 5 [95% CI, 2-12] MRIs per 1000 women; copay, 6 [95% CI, 3-6] MRI per 100 women; deductible, 6 [95% CI, 3-9] MRIs per 1000 women. Conclusions and Relevance Despite policies designed to remove financial barriers to access for breast cancer screening, significant financial barriers remain for women at risk of breast cancer.
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Affiliation(s)
- Danny R Hughes
- College of Health Solutions, Arizona State University, Phoenix
- School of Economics, Georgia Institute of Technology, Atlanta
- Department of Radiology and Imaging Sciences, Emory University, Atlanta, Georgia
| | - William Espinoza
- now with Novant Health, Charlotte, North Carolina
- Georgia Institute of Technology, Atlanta
| | - Sarah Fein
- Georgia Institute of Technology, Atlanta
- now with Biofourmis, Inc., Boston, Massachusetts
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Santavicca S, Hughes DR, Rosenkrantz AB, Rubin E, Duszak R. Professional Services Rendered by Nurse Practitioners and Physician Assistants Employed by Radiology Practices: Characteristics and Trends From 2017 Through 2019. J Am Coll Radiol 2023; 20:117-126. [PMID: 36008228 DOI: 10.1016/j.jacr.2022.06.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Revised: 06/05/2022] [Accepted: 06/07/2022] [Indexed: 11/27/2022]
Abstract
PURPOSE With radiology practices increasingly employing nonphysician practitioners (NPPs), we aimed to characterize specific NPP clinical roles. METHODS Linking 2017 to 2019 Medicare data sets, we identified all claims-submitting nurse practitioners and physician assistants (together NPPs) employed by radiologists. NPP-billed services were identified, weighted by work relative value units, and categorized as (1) clinical evaluation and management (E&M), (2) invasive procedures, and (3) noninvasive imaging interpretation. NPP practice patterns were assessed temporally and using frequency analysis. RESULTS As the number of radiologist-employed NPPs submitting claims increased 16.3% (from 523 in 2017 to 608 in 2019), their aggregate Medicare fee-for-service work relative value units increased 17.3% (+40.0% for E&M [from 79,540 to 111,337]; +5.6% for procedures [from 179,044 to 189,003]; and +74.0% for imaging [from 5,087 to 8,850]). The number performing E&M, invasive procedures, and imaging interpretation increased 7.6% (from 329 to 354), 18.3% (from 387 to 458), and 31.8% (from 85 to 112), with 58.2%, 75.3%, and 18.4% billing those services in 2019. Paracentesis and thoracentesis were the most frequently billed invasive procedures. Fluoroscopic swallowing and bone densitometry examinations were the most frequently billed imaging services. By region, NPPs practicing as majority clinical E&M providers were most common in the Midwest (33.5%) and South (33.0%), majority proceduralists in the South (53.1%), and majority image interpreters in the Midwest (50.0%). CONCLUSIONS As radiology practices employ more NPPs, radiologist-employed NPPs' aggregate services have increased for E&M, invasive procedures, and imaging interpretation. Most radiologist-employed NPPs perform invasive procedures and E&M. Although performed by a small minority, imaging interpretation has shown the largest relative service growth.
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Affiliation(s)
- Stefan Santavicca
- Senior Data Analyst, Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia.
| | - Danny R Hughes
- Professor, School of Economics and Director, Health Economics and Analytics Lab, Georgia Institute of Technology, Atlanta, Georgia; and Department of Radiology and Imaging Sciences, Emory University, Atlanta, Georgia
| | - Andrew B Rosenkrantz
- Professor, Director of Prostate Imaging, Director of Health Policy, and Section Chief of Abdominal Imaging, Department of Radiology, NYU Langone Medical Center, New York, New York
| | - Eric Rubin
- Chief, CT Scan, Southeast Radiology Limited, Ridley Park, Pennsylvania
| | - Richard Duszak
- Professor and Vice Chair of Radiology, Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia
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Duszak R, Hughes DR. Accurately reporting Medicare enrollment. Clin Imaging 2023; 93:122. [PMID: 35659785 DOI: 10.1016/j.clinimag.2022.05.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2022] [Accepted: 05/16/2022] [Indexed: 11/03/2022]
Affiliation(s)
- Richard Duszak
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, GA, United States of America.
| | - Danny R Hughes
- School of Economics, Georgia Institute of Technology, Atlanta, GA, United States of America.
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Liao JM, Hughes DR, Shetty S, Lee CI. JACR Health Policy Expert Panel: Bundled Payments. J Am Coll Radiol 2022; 19:1350-1352. [PMID: 36265812 DOI: 10.1016/j.jacr.2022.08.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Accepted: 08/26/2022] [Indexed: 11/06/2022]
Affiliation(s)
- Joshua M Liao
- Medical Director of Payment Strategy and Associate Chair for Health Systems, Department of Medicine, University of Washington School of Medicine, Seattle, Washington.
| | - Danny R Hughes
- Director the Health Economics and Analytics Lab, School of Economics, Georgia Institute of Technology, Atlanta, Georgia; Department of Radiology and Imaging Sciences, Emory University, Atlanta, Georgia. https://twitter.com/economeer
| | - Sanjay Shetty
- President, Steward Healthcare, Dallas, Texas. https://twitter.com/SanjayRadMD
| | - Christoph I Lee
- Director of the Northwest Screening and Cancer Outcomes Research Enterprise, Department of Radiology, University of Washington School of Medicine, Seattle, Washington, and Deputy Editor of JACR. https://twitter.com/christophleemd
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Santavicca S, Willis MH, Friedberg EB, Hughes DR, Duszak R. Osteopathic Versus Allopathic Radiologist Workforce Characteristics: A Medicare Administrative and Claims Data Analysis. J Am Coll Radiol 2022; 19:997-1005. [PMID: 35931137 DOI: 10.1016/j.jacr.2022.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Revised: 06/02/2022] [Accepted: 06/04/2022] [Indexed: 11/16/2022]
Abstract
PURPOSE Radiologist medical school pathways have received little attention in recent workforce investigations. With osteopathic enrollment increasing, we assessed the osteopathic versus allopathic composition of the radiologist workforce. METHODS Linking separate Medicare Doctors and Clinicians Initiative databases and Physician and Other Supplier Files from 2014 through 2019, we assessed (descriptively and using multivariate panel logistic regression modeling) individual and practice characteristics of radiologists who self-reported medical degrees. RESULTS Between 2014 and 2019, as the number of osteopathic radiologists increased 46.0% (4.7% to 6.0% of total radiologist workforce), the number of allopathic radiologists increased 12.1% (representing a relative workforce decrease from 95.3% to 94.0%). For each year since completing training, practicing radiologists were 3.7% less likely to have osteopathic (versus allopathic) degrees (odds ratio [OR] = 0.96 per year, P < .01). Osteopathic radiologists were less likely to work in urban (versus rural) areas (OR = 0.95), and compared with the Midwest, less likely to work in the Northeast (OR = 0.96), South (OR = 0.95), and West (OR = 0.94) (all P < .01). Except for cardiothoracic imaging (OR = 0.78, P = .24), osteopathic radiologists were more likely than allopathic radiologists to practice as general (rather than subspecialty) radiologists (range OR = 0.37 for nuclear medicine to OR = 0.65 for neuroradiology, all P < .01). CONCLUSIONS Osteopathic physicians represent a fast-growing earlier-career component of the radiologist workforce. Compared with allopathic radiologists, they more frequently practice as generalist radiologists, in rural areas, and in the Midwest. Given recent calls for greater general and rural radiology coverage, increasing osteopathic representation in the national radiologist workforce could improve patient access.
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Affiliation(s)
- Stefan Santavicca
- Senior Data Analyst, Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia.
| | - Marc H Willis
- Clinical Professor and Associate Chair of Quality Improvement, Department of Radiology, Stanford University School of Medicine, Stanford, California
| | - Eric B Friedberg
- Associate Professor, Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia
| | - Danny R Hughes
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia; Professor, School of Economics, Director, Health Economics and Analytics Lab (HEAL), Georgia Institute of Technology, Atlanta, Georgia
| | - Richard Duszak
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia; Professor, Vice Chair for Health Policy and Practice, Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia; and Chair, Commission on Leadership and Practice Development, American College of Radiology
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French RJ, Hirsch J, Hemingway J, Hughes DR, Lerebours R, Luo S, Allen BC, Duszak R, Rosman DA. Association and Trends in Medicare Denials and Utilization for Brain CT: Indirect Impacts by Targeted Policy Intervention? Curr Probl Diagn Radiol 2022; 52:31-34. [DOI: 10.1067/j.cpradiol.2022.07.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2022] [Accepted: 07/27/2022] [Indexed: 11/22/2022]
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Tharp K, Santavicca S, Hughes DR, Kishore D, Banja JD, Duszak R. Characteristics of Radiologists Serving as Medical Malpractice Expert Witnesses for Defense Versus Plaintiff. J Am Coll Radiol 2022; 19:807-813. [PMID: 35654146 DOI: 10.1016/j.jacr.2022.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 04/01/2022] [Accepted: 04/22/2022] [Indexed: 12/01/2022]
Abstract
PURPOSE Previous studies have reported higher qualification characteristics for anesthesiologists, neurosurgeons, orthopedic surgeons, and otolaryngologists serving as defense (versus plaintiff) medical malpractice expert witnesses. We assessed such characteristics for radiologist expert witnesses. METHODS Using the Westlaw legal research database, we identified radiologists serving as experts in all indexed medical malpractice cases between 2010 and 2019. Online databases were used to identify years of practice experience and scholarly bibliometrics. Using Medicare claims, individual radiologist practice types and mixes were ascertained. Radiologists testifying at least once each for defense and plaintiff were excluded from our defense-only versus plaintiff-only comparative analysis. RESULTS Initial Boolean searches yielded 1,042 potential cases; subsequent manual review identified 179 radiologists testifying in 231 lawsuits: 143 testified in one case (58 defense, 85 plaintiff) and 36 testified in multiple cases (10 defense-only, 14 plaintiff-only, 12 both). The 68 defense-only experts had fewer years of practice experience than the 99 plaintiff-only experts (28.3 versus 31.8 years, P = .02), but the two groups were otherwise similar in both practice type (44.6% versus 54.9% academic, P = .62) and mix (63.8% versus 65.8% practiced as subspecialists, P = .37) and as well as numbers of publications (60.5 versus 62.8, P = .86), citations (1,994.1 versus 2,309.2, P = .56), and h-indices (17.2 versus 16.8, P = .89). CONCLUSIONS In contrast to other specialists, radiologists serving as medical malpractice expert witnesses for defense and plaintiff display similar qualifications across various characteristics. Published practice parameter guidelines and experts' ability to blindly review archived original images might together explain this interspecialty discordance.
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Affiliation(s)
- Kenneth Tharp
- Department of Radiology and Imaging Sciences, Emory University School of Medicine.
| | - Stefan Santavicca
- Department of Radiology and Imaging Sciences, Emory University School of Medicine
| | - Danny R Hughes
- Department of Radiology and Imaging Sciences, Emory University School of Medicine; Director of the Health Economics and Analytics Laboratory (HEAL), School of Economics, Georgia Institute of Technology
| | - Divya Kishore
- Department of Radiology and Imaging Sciences, Emory University School of Medicine
| | | | - Richard Duszak
- Vice Chair of the Department of Radiology and Imaging Sciences, and Director of the Imaging Policy Analytics for Clinical Transformation (IMPACT) Research Center, Department of Radiology and Imaging Sciences, Emory University School of Medicine; ACR Board of Chancellors
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Duszak R, Hemingway J, Christensen EW, Saindane AM, Hughes DR, Rula EY. An Empiric Medicare Claims-Based Utilization Approach to Mitigating the Iodinated Contrast Shortage. J Am Coll Radiol 2022; 19:846-848. [PMID: 35643182 PMCID: PMC9131464 DOI: 10.1016/j.jacr.2022.05.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 05/17/2022] [Accepted: 05/17/2022] [Indexed: 11/25/2022]
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Santavicca S, Hughes DR, Rosenkrantz AB, Rubin E, Duszak R. Radiology Practices Employing Nurse Practitioners and Physician Assistants: Characteristics and Trends From 2017 Through 2019. J Am Coll Radiol 2022; 19:746-753. [DOI: 10.1016/j.jacr.2022.02.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Revised: 02/04/2022] [Accepted: 02/07/2022] [Indexed: 01/21/2023]
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Allen JW, Peterson RB, Hughes DR, Hemingway J, Rula EY, Rubin E, Duszak R. Evolving Radiology Trainee Neuroimaging Workloads: A National Medicare Claims-based Analysis. Acad Radiol 2022; 29 Suppl 3:S215-S221. [PMID: 34400079 DOI: 10.1016/j.acra.2021.07.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Revised: 07/06/2021] [Accepted: 07/07/2021] [Indexed: 11/20/2022]
Abstract
RATIONALE AND OBJECTIVES While radiology training programs aim to prepare trainees for clinical practice, the relationship between trainee, and national radiology workforce demands is unclear. This study assesses changing radiology trainee neuroimaging workloads nationwide for neuroimaging studies. MATERIALS AND METHODS Using aggregate Medicare claims files from 2002 to 2018, we identified all computed tomography (CT) and magnetic resonance (MR) examinations of the brain, head and neck, and spine (hereafter "neuroimaging") in Medicare fee-for-service beneficiaries nationwide. Using separate Medicare files, we calculated population utilization rates, and work relative value unit (wRVU) weights of all diagnostic neuroradiology services. Using claims modifiers, we identified services rendered by radiology trainees. Using separate national trainee enrollment files, we calculated mean annual per trainee wRVUs. RESULTS Between 2002 and 2018, total Medicare neuroimaging claims increased for both radiologists overall (86.1%) and trainees (162.5%), including increases in both CT (102.9% vs 196.8%), and MR (59.9% vs 106.6%). The national percentage of all radiologist neuroimaging wRVUs rendered by trainees increased 46.1% (3.8% of all wRVUs nationally in 2002 to 5.6% in 2018). National trainee increases were present across all neuroimaging services but greatest for head and neck CT (+86.5%). Mean annual per radiology trainee neuroimaging Medicare wRVUs increased +174.9% (42.1 per trainee in 2002 to 115.70 in 2018). Mean per trainee wRVU increases were greatest for spine CT (+394.2%) but present across all neuroimaging services. CONCLUSION As neuroimaging utilization in Medicare beneficiaries has grown, radiology trainee neuroimaging workloads have increased disproportionately.
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Affiliation(s)
- Jason W Allen
- Department of Radiology and Imaging Sciences, Emory University School of Medicine,1364 Clifton Rd NE, Atlanta, GA 30332.
| | - Ryan B Peterson
- Department of Radiology and Imaging Sciences, Emory University School of Medicine,1364 Clifton Rd NE, Atlanta, GA 30332
| | - Danny R Hughes
- Georgia Institute of Technology School of Economics, Old C.E. Building, 221 Bobby Dodd Way, Atlanta, GA 30332
| | - Jennifer Hemingway
- Harvey L. Neiman Health Policy Institute, 1891 Preston White Dr., Reston, VA 20191
| | - Elizabeth Y Rula
- Harvey L. Neiman Health Policy Institute, 1891 Preston White Dr., Reston, VA 20191
| | - Eric Rubin
- Crozer Health, 1 Medical Center Blvd, Upland, PA 19013
| | - Richard Duszak
- Department of Radiology and Imaging Sciences, Emory University School of Medicine,1364 Clifton Rd NE, Atlanta, GA 30332
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Abashidze N, Stecher C, Rosenkrantz AB, Duszak R, Hughes DR. Racial and Ethnic Disparities in the Use of Prostate Magnetic Resonance Imaging Following an Elevated Prostate-Specific Antigen Test. JAMA Netw Open 2021; 4:e2132388. [PMID: 34748010 PMCID: PMC8576586 DOI: 10.1001/jamanetworkopen.2021.32388] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
IMPORTANCE Prostate cancer screening and diagnosis exhibit known racial and ethnic disparities. Whether these disparities persist in prostate magnetic resonance imaging (MRI) utilization after elevated prostate-specific antigen (PSA) results is poorly understood. OBJECTIVE To assess potential racial and ethnic disparities in prostate MRI utilization following elevated PSA results. DESIGN, SETTING, AND PARTICIPANTS This cohort study of 794 809 insured US men was drawn from deidentified medical claims between January 2011 and December 2017 obtained from a commercial claims database. Eligible participants were aged 40 years and older and received a single PSA result and no prior PSA screening or prostate MRI claims. Analysis was performed in January 2021. MAIN OUTCOMES AND MEASURES Multivariable logistic regression was used to examine associations between elevated PSA results and follow-up prostate MRI. For patients receiving prostate MRI, multivariable regressions were estimated for the time between PSA and subsequent prostate MRI. PSA thresholds explored included PSA levels above 2.5 ng/mL, 4 ng/mL, and 10 ng/mL. Analyses were stratified by race, ethnicity, and age. RESULTS Of 794 809 participants, 51 500 (6.5%) had PSA levels above 4 ng/mL; of these, 1524 (3.0%) underwent prostate MRI within 180 days. In this sample, mean (SD) age was 59.8 (11.3) years (range 40-89 years); 31 350 (3.9%) were Asian, 75 935 (9.6%) were Black, 107 956 (13.6%) were Hispanic, and 455 214 (57.3%) were White. Compared with White patients, Black patients with PSA levels above 4 ng/mL and 10 ng/mL were 24.1% (odds ratio [OR], 0.78; 95% CI, 0.65-0.89) and 35.0% (OR, 0.65; 95% CI, 0.50-0.85) less likely to undergo subsequent prostate MRI, respectively. Asian patients with PSA levels higher than 4 ng/mL (OR, 0.76; 95% CI, 0.58-0.99) and Hispanic patients with PSA levels above 10 ng/mL (OR, 0.77; 95% CI, 0.59-0.99) were also less likely to undergo subsequent prostate MRI compared with White patients. Black patients between ages 65 and 74 years with PSA above 4 ng/mL and 10 ng/mL were 23.6% (OR, 0.76; 95% CI, 0.64-0.91) and 43.9% (OR, 0.56; 95% CI, 0.35-0.91) less likely to undergo MRI, respectively. Race and ethnicity were not significantly associated with mean time between PSA and MRI. CONCLUSIONS AND RELEVANCE Among men with elevated PSA results, racial and ethnic disparities were evident in subsequent prostate MRI utilization and were more pronounced at higher PSA thresholds. Further research is needed to better understand and mitigate physician decision-making biases and other potential sources of disparities in prostate cancer diagnosis and management.
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Affiliation(s)
- Nino Abashidze
- Haub School of Environment and Natural Resources, University of Wyoming, Laramie
| | - Chad Stecher
- College of Health Solutions, Arizona State University, Phoenix
| | | | - Richard Duszak
- Department of Radiology and Imaging Sciences, Emory University, Atlanta, Georgia
| | - Danny R. Hughes
- Department of Radiology and Imaging Sciences, Emory University, Atlanta, Georgia
- School of Economics, Georgia Institute of Technology, Atlanta
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ElHabr AK, Katz JM, Wang J, Bastani M, Martinez G, Gribko M, Hughes DR, Sanelli P. Predicting 90-day modified Rankin Scale score with discharge information in acute ischaemic stroke patients following treatment. BMJ Neurol Open 2021; 3:e000177. [PMID: 34250487 PMCID: PMC8231000 DOI: 10.1136/bmjno-2021-000177] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Accepted: 05/30/2021] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVES To understand variability in modified Rankin Scale scores from discharge to 90 days in acute ischaemic stroke patients following treatment, and examine prediction of 90-day modified Rankin Scale score by using discharge modified Rankin Scale and discharge disposition. MATERIALS AND METHODS Retrospective analysis of acute ischaemic stroke patients following treatment was performed from January 2016 to March 2020. Data collection included demographic and clinical characteristics and outcomes data (modified Rankin Scale score at discharge, 30 days and 90 days and discharge disposition). Pearson's χ2 test assessed statistical differences in distribution of modified Rankin Scale scores at discharge, 30 days and 90 days. The predictive power of discharge modified Rankin Scale score and disposition quantified the association with 90-day outcome. RESULTS A total of 280 acute ischaemic stroke patients (65.4% aged ≥65 years, 47.1% female, 60.7% white) were included in the analysis. The modified Rankin Scale score significantly changed between 30 and 90 days from discharge (p<0.001) after remaining stable from discharge to 30 days (p=0.665). The positive and negative predictive values of an unfavourable long-term outcome for discharge modified Rankin Scale scores of 3-5 were 67.7% (95% CI 60.4% to 75.0%) and 82.0% (95% CI 75.1% to 88.8%), and for non-home discharge disposition were 72.4% (95% CI 64.5% to 80.2%) and 74.5% (95% CI 67.8% to 81.3%), respectively. CONCLUSIONS Discharge modified Rankin Scale score and non-home discharge disposition are good individual predictors of 90-day modified Rankin Scale score for ischaemic stroke patients following treatment.
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Affiliation(s)
- Andrew K ElHabr
- Department of Industrial and Systems Engineering, Georgia Institute of Technology, Atlanta, Georgia, USA
| | - Jeffrey M Katz
- Department of Neurology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Manhasset, New York, USA
- Department of Radiology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, USA
| | - Jason Wang
- Department of Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, USA
- Center for Health Innovations and Outcomes Research, Feinstein Institute for Medical Research, Manhasset, New York, USA
| | - Mehrad Bastani
- Center for Health Innovations and Outcomes Research, Feinstein Institute for Medical Research, Manhasset, New York, USA
| | | | - Michele Gribko
- Department of Neurology, North Shore University Hospital at Manhasset, Manhasset, New York, USA
| | - Danny R Hughes
- School of Economics, Georgia Institute of Technology, Atlanta, Georgia, USA
- Department of Radiology and Imaging Sciences, Emory University, Atlanta, Georgia, USA
| | - Pina Sanelli
- Department of Radiology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, USA
- Center for Health Innovations and Outcomes Research, Feinstein Institute for Medical Research, Manhasset, New York, USA
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18
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Hughes DR, Filar C, Mitchell DT. Nurse practitioner scope of practice and the prevention of foot complications in rural diabetes patients. J Rural Health 2021; 38:994-998. [PMID: 34101273 DOI: 10.1111/jrh.12599] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
PURPOSE Diabetic foot ulcers afflict a quarter of type-2 diabetes mellitus patients and are associated with higher mortality rates among people with diabetes. Routine primary and preventive care is essential to both prevent and treat foot ulcers before they can contribute to further adverse outcomes. One approach for expanding this care to people with diabetes in rural communities is increasing the practice authority of nurse practitioners. This study examines whether the presence of nurse practitioner practice authority is associated with fewer foot ulcer complications in rural populations as measured through the incidence of foot debridement-a common procedure for addressing severe diabetic foot ulcers. METHODS This study uses medical claims to estimate the incidence of foot debridement for US counties. A multivariable linear regression was performed to examine the association between nurse practitioner practice authority and the county incidence of foot debridement after adjusting for measures of local health care workforce and sociodemographics. FINDINGS Nurse practitioner practice authority was associated with 219.4 fewer foot debridements per 10,000 enrollees (P < .001) in rural counties. Rural health clinics (P < .03) and skilled nursing facilities (P < .03) were also associated with fewer rural debridements. The number of nurse practitioners (P < .69) and primary care physicians (P < .69) per enrollee were not significant. No measure of health care workforce was associated with the incidence of foot debridement in urban counties. CONCLUSIONS Expanding nurse practitioner practice authority may be an effective solution for preventing complications from diabetic foot ulcers in rural communities.
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Affiliation(s)
- Danny R Hughes
- School of Economics, Georgia Institute of Technology, Atlanta, Georgia, USA.,Department of Radiology and Imaging Sciences, Emory University, Atlanta, Georgia, USA
| | - Candice Filar
- School of Economics, Georgia Institute of Technology, Atlanta, Georgia, USA
| | - David T Mitchell
- Department of Economics, Finance, Insurance, and Risk Management, University of Central Arkansas, Conway, Arkansas, USA
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19
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Johnson DR, Waid MD, Rula EY, Hughes DR, Rosenkrantz AB, Duszak R. Comparison of Radiologists and Other Specialists in the Performance of Lumbar Puncture Procedures Over Time. AJNR Am J Neuroradiol 2021; 42:1174-1181. [PMID: 33664117 DOI: 10.3174/ajnr.a7049] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2020] [Accepted: 11/26/2020] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Lumbar punctures may be performed by many different types of health care providers. We evaluated the percentages of lumbar punctures performed by radiologists-versus-nonradiologist providers, including changes with time and discrepancies between specialties. MATERIALS AND METHODS Lumbar puncture procedure claims were identified in a 5% sample of Medicare beneficiaries from 2004 to 2017 and classified by provider specialty, site of service, day of week, and patient complexity. Compound annual growth rates for 2004 versus 2017 were calculated; t test and χ2 statistical analyses were performed. RESULTS Lumbar puncture use increased from 163.3 to 203.4 procedures per 100,000 Medicare beneficiaries from 2004 to 2017 (overall rate, 190.3). Concurrently, the percentage of lumbar punctures performed by radiologists increased from 37.1% to 54.0%, while proportions performed by other major physician specialty groups either declined (eg, neurologists from 23.5% to 10.0%) or were largely unchanged. While radiologists saw the largest absolute increase in the percentage of procedures, the largest relative increase occurred for nonphysician providers (4.2% in 2004 to 7.5% in 2017; +78.6%). In 2017, radiologists performed most procedures on weekdays (56.2%) and a plurality on weekends (38.2%). Comorbidity was slightly higher in patients undergoing lumbar puncture by radiologists (P < .001). CONCLUSIONS Radiologists now perform most lumbar puncture procedures for Medicare beneficiaries in both the inpatient and outpatient settings. The continuing shift in lumbar puncture responsibility from other specialists to radiologists has implications for clinical workflows, cost, radiation exposure, and postgraduate training.
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Affiliation(s)
- D R Johnson
- From the Department of Radiology (D.R.J.), Mayo Clinic, Rochester, Minnesota
- Department of Neurology (D.R.J.), Mayo Clinic, Rochester, Minnesota
| | - M D Waid
- Harvey L. Neiman Health Policy Institute (M.D.W., E.Y.R., D.R.H.), Reston, Virginia
| | - E Y Rula
- Harvey L. Neiman Health Policy Institute (M.D.W., E.Y.R., D.R.H.), Reston, Virginia
| | - D R Hughes
- Harvey L. Neiman Health Policy Institute (M.D.W., E.Y.R., D.R.H.), Reston, Virginia
- School of Economics (D.R.H.), Georgia Institute of Technology, Atlanta, Georgia
| | - A B Rosenkrantz
- Department of Radiology (A.B.R.), NYU Langone Health, New York, New York
| | - R Duszak
- Department of Radiology and Imaging Sciences (R.D.), Emory University School of Medicine, Atlanta, Georgia
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20
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Santavicca S, Duszak R, Nicola GN, Golding LP, Rosenkrantz AB, Wernz C, Hughes DR. Evolving Radiologist Participation in Medicare Shared Savings Program Accountable Care Organizations. J Am Coll Radiol 2021; 18:1332-1341. [PMID: 34022135 DOI: 10.1016/j.jacr.2021.04.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 04/21/2021] [Accepted: 04/28/2021] [Indexed: 11/19/2022]
Abstract
PURPOSE The aim of this study was to temporally characterize radiologist participation in Medicare Shared Savings Program (MSSP) accountable care organizations (ACOs). METHODS Using CMS Physician and Other Supplier Public Use Files, ACO provider-level Research Identifiable Files, and Shared Savings Program ACO Public-Use Files for 2013 through 2018, characteristics of radiologist ACO participation were assessed over time. RESULTS Between 2013 and 2018, the percentage of Medicare-participating radiologists affiliated with MSSP ACOs increased from 10.4% to 34.9%. During that time, the share of large ACOs (>20,000 beneficiaries) with participating radiologists averaged 87.0%, and the shares of medium ACOs (10,000-20,000) and small ACOs (<10,000) with participating radiologists rose from 62.5% to 66.0% and from 26.3% to 51.6%, respectively. The number of physicians in MSSP ACOs with radiologists was substantially larger than those without radiologists (mean range across years, 573-945 versus 107-179). Primary care physicians constituted a larger percentage of the physician population for ACOs without radiologists (average across years, 66.3% versus 38.5%), and ACOs with radiologists had a higher rate of specialist representation (56.0% versus 33.7%). Beneficiary age, race, and sex demographics were similar among radiologist-participating versus nonparticipating ACOs. CONCLUSIONS In recent years, radiologist participation in MSSP ACOs has increased substantially. ACOs with radiologist participation are large and more diverse in their physician specialty composition. Nonparticipating radiologists should prepare accordingly.
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Affiliation(s)
- Stefan Santavicca
- School of Economics, Georgia Institute of Technology, Atlanta, Georgia.
| | - Richard Duszak
- Professor and Vice Chair of Radiology, Department of Radiology and Imaging Sciences, Emory University, Atlanta, Georgia
| | - Gregory N Nicola
- Finance Chair and Board Member at Hackensack Meridian Health Partners Clinically Integrated Network; Executive leadership position at Hackensack Radiology Group, River Edge, New Jersey
| | - Lauren Parks Golding
- Executive Committee Chair, and Clinical Operations Chair, Triad Radiology Associates, Winston Salem, North Carolina
| | - Andrew B Rosenkrantz
- Professor of Radiology and Urology, Director of Prostate Imaging, Director of Health Policy, and Section Chief of Abdominal Imaging, Department of Radiology, NYU Langone Medical Center, New York, New York
| | - Christian Wernz
- Department of Data Science, University of Virginia Health System, Charlottesville, Virginia
| | - Danny R Hughes
- Professor and Vice Chair of Radiology, Department of Radiology and Imaging Sciences, Emory University, Atlanta, Georgia; Professor, School of Economics, Georgia Institute of Technology, Director, Health Economics and Analytics Lab (HEAL), Atlanta, Georgia
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21
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Wernz C, Song Y, Hughes DR. How hospitals can improve their public quality metrics: a decision-theoretic model. Health Care Manag Sci 2021; 24:702-715. [PMID: 33991292 DOI: 10.1007/s10729-021-09551-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Accepted: 01/29/2021] [Indexed: 10/21/2022]
Abstract
The public reporting of hospitals' quality of care is providing additional motivation for hospitals to deliver high-quality patient care. Hospital Compare, a consumer-oriented website by the Centers for Medicare and Medicaid Services (CMS), provides patients with detailed quality of care data on most US hospitals. Given that many quality metrics are the aggregate result of physicians' individual clinical decisions, the question arises if and how hospitals could influence their physicians so that their decisions positively contribute to hospitals' quality goals. In this paper, we develop a decision-theoretic model to explore how three different hospital interventions-incentivization, training, and nudging-may affect physicians' decisions. We focus our analysis on Outpatient Measure 14 (OP-14), which is an imaging quality metric that reports the percentage of outpatients with a brain computed tomography (CT) scan, who also received a same-day sinus CT scan. In most cases, same-day brain and sinus CT scans are considered unnecessary, and high utilizing hospitals aim to reduce their OP-14 metric. Our model captures the physicians' imaging decision process accounting for medical and behavioral factors, in particular the uncertainty in clinical assessment and a physician's diagnostic ability. Our analysis shows how hospital interventions of incentivization, training, and nudging affect physician decisions and consequently OP-14. This decision-theoretic model provides a foundation to develop insights for policy makers on the multi-level effects of their policy decisions.
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Affiliation(s)
- Christian Wernz
- Department of Data Science, University of Virginia Health System, Charlottesville, VA, USA.
| | - Yongjia Song
- Department of Industrial Engineering, Clemson University, Clemson, SC, USA
| | - Danny R Hughes
- School of Economics, Georgia Institute of Technology, Atlanta, GA, USA
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22
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Santavicca S, Hughes DR, Fleishon HB, Lexa F, Rubin E, Rosenkrantz AB, Duszak R. Radiologist-Practice Separation: Recent Trends and Characteristics. J Am Coll Radiol 2021; 18:580-589. [DOI: 10.1016/j.jacr.2020.10.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Revised: 10/05/2020] [Accepted: 10/06/2020] [Indexed: 11/26/2022]
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Wintermark M, Rosenkrantz AB, Rezaii PG, Fredericks N, Cerdas LC, Burleson J, Haines GR, Chatfield M, Thorwarth WT, Duszak R, Hughes DR. Predicted Cost Savings Achieved by the Radiology Support, Communication and Alignment Network from Reducing Medical Imaging Overutilization in the Medicare Population. J Am Coll Radiol 2021; 18:704-712. [PMID: 33444562 DOI: 10.1016/j.jacr.2020.12.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Revised: 12/02/2020] [Accepted: 12/02/2020] [Indexed: 11/27/2022]
Abstract
OBJECTIVE The Radiology Support, Communication and Alignment Network (R-SCAN) is a quality improvement program through which patients, referring clinicians, and radiologists collaborate to improve imaging appropriateness based on Choosing Wisely recommendations and ACR Appropriateness Criteria. R-SCAN was shown previously to increase the odds of obtaining an appropriate, higher patient or diagnostic value, imaging study. In the current study, we aimed to estimate the potential imaging cost savings associated with R-SCAN use for the Medicare population. MATERIAL AND METHODS The R-SCAN data set was used to determine the proportion of appropriate and lesser value imaging studies performed, as well as the percent change in the total number of imaging studies performed, before and after an R-SCAN educational intervention. Using a separate CMS data set, we then identified the total number of relevant imaging studies and associated total costs using a 5% sample of Medicare beneficiaries in 2017. We applied R-SCAN proportions to the CMS data set to estimate the potential impact of the R-SCAN interventions across a broader Medicare population. RESULTS We observed a substantial reduction in the costs associated with lesser value imaging in the R-SCAN cohort, totaling $260,000 over 3.5 months. When extrapolated to the Medicare population, the potential cost reductions associated with the decrease in lesser value imaging totaled $433 million yearly. CONCLUSION If expanded broadly, R-SCAN interventions can result in substantial savings to the Medicare program.
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Affiliation(s)
- Max Wintermark
- Stanford University, Department of Radiology, Neuroradiology Division, Stanford, California.
| | | | - Paymon G Rezaii
- Stanford University, Department of Radiology, Neuroradiology Division, Stanford, California
| | | | | | | | | | | | | | - Richard Duszak
- Professor and Vice Chair of Radiology, Department of Radiology and Imaging Sciences, Emory University, Atlanta, Georgia
| | - Danny R Hughes
- Harvey L. Neiman Health Policy Institute, Reston, Virginia; Executive Director and Senior Research Fellow, Harvey L. Neiman Health Policy Institute, Reston, Virginia; Professor, School of Economics, Director, Health Economics and Analytics Lab (HEAL), Georgia Institute of Technology, Atlanta, Georgia
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24
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Villalobos A, Horný M, Hughes DR, Duszak R. Associations Over Time Between Paid Medical Malpractice Claims and Imaging Utilization in the United States. J Am Coll Radiol 2021; 18:34-41. [DOI: 10.1016/j.jacr.2020.04.035] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Revised: 04/13/2020] [Accepted: 04/13/2020] [Indexed: 12/01/2022]
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25
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Asnafi S, Duszak R, Hemingway JM, Hughes DR, Allen JW. Evolving Use of fMRI in Medicare Beneficiaries. AJNR Am J Neuroradiol 2020; 41:1996-2000. [PMID: 33033048 DOI: 10.3174/ajnr.a6845] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Accepted: 06/22/2020] [Indexed: 11/07/2022]
Abstract
Using the Medicare Physician-Supplier Procedure Summary Master File, we evaluated the evolving use of fMRI in Medicare fee-for-service beneficiaries from 2007 through 2017. Annual use rates (per 1,000,000 enrollees) increased from 17.7 to 32.8 through 2014 and have remained static since. Radiologists have remained the dominant specialty group from 2007 to 2017 (86.4% and 88.6% of all services, respectively), and the outpatient setting has remained the dominant place of service (65.4% and 65.4%, respectively).
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Affiliation(s)
- S Asnafi
- From the Department of Radiology and Imaging Sciences (S.A., R.D., J.W.A.)
| | - R Duszak
- From the Department of Radiology and Imaging Sciences (S.A., R.D., J.W.A.)
| | - J M Hemingway
- Harvey L. Neiman Health Policy Institute (J.M.H., D.R.H.), Reston, Virginia
| | - D R Hughes
- Harvey L. Neiman Health Policy Institute (J.M.H., D.R.H.), Reston, Virginia
- School of Economics (D.R.H.), Georgia Institute of Technology, Atlanta, Georgia
| | - J W Allen
- From the Department of Radiology and Imaging Sciences (S.A., R.D., J.W.A.)
- Neurology (J.W.A.), Emory University School of Medicine, Atlanta, Georgia
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26
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Duszak R, Maze J, Sessa C, Fleishon HB, Golding LP, Nicola GN, Hughes DR. Characteristics of COVID-19 Community Practice Declines in Noninvasive Diagnostic Imaging Professional Work. J Am Coll Radiol 2020; 17:1453-1459. [PMID: 32682745 PMCID: PMC7332916 DOI: 10.1016/j.jacr.2020.06.031] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 06/26/2020] [Accepted: 06/29/2020] [Indexed: 12/13/2022]
Abstract
PURPOSE The operational and financial impact of the widespread coronavirus disease 2019 (COVID-19) curtailment of imaging services on radiology practices is unknown. We aimed to characterize recent COVID-19-related community practice noninvasive diagnostic imaging professional work declines. METHODS Using imaging metadata from nine community radiology practices across the United States between January 2019 and May 2020, we mapped work relative value unit (wRVU)-weighted stand-alone noninvasive diagnostic imaging service codes to both modality and body region. Weekly 2020 versus 2019 wRVU changes were analyzed by modality, body region, and site of service. Practice share χ2 testing was performed. RESULTS Aggregate weekly wRVUs ranged from a high of 120,450 (February 2020) to a low of 55,188 (April 2020). During that -52% wRVU nadir, outpatient declines were greatest (-66%). All practices followed similar aggregate trends in the distribution of wRVUs between each 2020 versus 2019 week (P = .96-.98). As a percentage of total all-practice wRVUs, declines in CT (20,046 of 63,992; 31%) and radiography and fluoroscopy (19,196; 30%) were greatest. By body region, declines in abdomen and pelvis (16,203; 25%) and breast (12,032; 19%) imaging were greatest. Mammography (-17%) and abdominal and pelvic CT (-14%) accounted for the largest shares of total all-practice wRVU reductions. Across modality-region groups, declines were far greatest for mammography (-92%). CONCLUSIONS Substantial COVID-19-related diagnostic imaging work declines were similar across community practices and disproportionately impacted mammography. Decline patterns could facilitate pandemic second wave planning. Overall implications for practice workflows, practice finances, patient access, and payment policy are manifold.
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Affiliation(s)
- Richard Duszak
- Professor and Vice Chair of Radiology, Department of Radiology and Imaging Sciences, Emory University School of Medicine, and Emory Healthcare, Atlanta, Georgia.
| | - Jeff Maze
- Founder and CEO of Quinsite, LLC, Chapel Hill, North Carolina
| | - Candice Sessa
- School of Economics, Georgia Institute of Technology, Atlanta, Georgia
| | - Howard B Fleishon
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, and Emory Healthcare, Atlanta, Georgia; Division Director, Community Radiology, Atlanta, Georgia
| | - Lauren P Golding
- Executive Committee Chair, and Clinical Operations Chair, Triad Radiology Associates, Winston Salem, North Carolina
| | - Gregory N Nicola
- Finance Chair and Board Member at Hackensack Meridian Health Partners Clinically Integrated Network; Executive leadership position at Hackensack Radiology Group PA, River Edge, New Jersey
| | - Danny R Hughes
- Executive Director, Harvey L. Neiman Health Policy Institute, Washington, DC; Professor, School of Economics, Director, Health Economics and Analytics Lab (HEAL), Georgia Institute of Technology, Atlanta, Georgia
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Rosenkrantz AB, Chaves Cerdas L, Hughes DR, Recht MP, Nass SJ, Hricak H. National Trends in Oncologic Diagnostic Imaging. J Am Coll Radiol 2020; 17:1116-1122. [PMID: 32640248 PMCID: PMC7483645 DOI: 10.1016/j.jacr.2020.06.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 05/29/2020] [Accepted: 06/01/2020] [Indexed: 12/26/2022]
Abstract
OBJECTIVE To characterize national trends in oncologic imaging (OI) utilization. METHODS This retrospective cross-sectional study used 2004 and 2016 CMS 5% Carrier Claims Research Identifiable Files. Radiologist-performed, primary noninvasive diagnostic imaging examinations were identified from billed Current Procedural Terminology codes; CT, MRI, and PET/CT examinations were categorized as "advanced" imaging. OI examinations were identified from imaging claims' primary International Classification of Diseases-9 and International Classification of Diseases-10 codes. Imaging services were stratified by academic practice status and place of service. State-level correlations of oncologic advanced imaging utilization (examinations per 1,000 beneficiaries) with cancer prevalence and radiologist supply were assessed by Spearman correlation coefficient. RESULTS The national Medicare sample included 5,051,095 diagnostic imaging examinations (1,220,224 of them advanced) in 2004 and 5,023,115 diagnostic imaging examinations (1,504,608 of them advanced) in 2016. In 2004 and 2016, OI represented 4.3% and 3.9%, respectively, of all imaging versus 10.8% and 9.5%, respectively, of advanced imaging. The percentage of advanced OI done in academic practices rose from 18.8% in 2004 to 34.1% in 2016, leaving 65.9% outside academia. In 2016, 58.0% of advanced OI was performed in the hospital outpatient setting and 23.9% in the physician office setting. In 2016, state-level oncologic advanced imaging utilization correlated with state-level radiologist supply (r = +0.489, P < .001) but not with state-level cancer prevalence (r = -0.139, P = .329). DISCUSSION OI usage varied between practice settings. Although the percentage of advanced OI done in academic settings nearly doubled from 2004 to 2016, the majority remained in nonacademic practices. State-level oncologic advanced imaging utilization correlated with radiologist supply but not cancer prevalence.
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Affiliation(s)
- Andrew B Rosenkrantz
- Section chief, Abdominal Imaging, Director of Health Policy, and Director of Prostate Imaging, Department of Radiology, NYU Langone Health, New York, New York
| | | | - Danny R Hughes
- Harvey L. Neiman Health Policy Institute, Reston, Virginia; Georgia Institute of Technology, Atlanta, Georgia; Emory University, Atlanta, Georgia
| | - Michael P Recht
- Chairman, Department of Radiology, NYU Langone Health, New York, New York
| | - Sharyl J Nass
- National Academies of Sciences, Engineering, and Medicine, Washington, DC
| | - Hedvig Hricak
- Chair, Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, New York.
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Rosenkrantz AB, Hughes DR, Duszak R. Increasing Subspecialization of the National Radiologist Workforce. J Am Coll Radiol 2020; 17:812-818. [DOI: 10.1016/j.jacr.2019.11.027] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Revised: 11/20/2019] [Accepted: 11/22/2019] [Indexed: 10/25/2022]
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Wu X, Khunte M, Gandhi D, Matouk C, Hughes DR, Sanelli P, Malhotra A. Implications of achieving TICI 2b vs TICI 3 reperfusion in patients with ischemic stroke: a cost-effectiveness analysis. J Neurointerv Surg 2020; 12:1161-1165. [PMID: 32457225 DOI: 10.1136/neurintsurg-2020-015873] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Revised: 03/11/2020] [Accepted: 03/13/2020] [Indexed: 01/19/2023]
Abstract
BACKGROUND The benefit of endovascular thrombectomy (EVT) in stroke patients with large-vessel occlusion (LVO) depends on the degree of recanalization achieved. We aimed to determine the health outcomes and cost implications of achieving TICI 2b vs TICI 3 reperfusion in acute stroke patients with LVO. METHODS A decision-analytic study was performed with Markov modeling to estimate the lifetime quality-adjusted life years (QALY) of EVT-treated patients, and costs based on the degree of reperfusion achieved. The study was performed with a societal perspective in the United States' setting. The base case calculations were performed in three age groups: 55-, 65-, and 75-year-old patients. RESULTS Within 90 days, achieving TICI 3 resulted in a cost saving of $3676 per patient and health benefit of 11 days in perfect health as compared with TICI 2b. In the long term, for the three age groups, achieving TICI 3 resulted in cost savings of $46,498, $25,832, and $15 719 respectively, and health benefits of 2.14 QALYs, 1.71 QALYs, and 1.23 QALYs. Every 1% increase in TICI 3 in 55-year-old patients nationwide resulted in a cost saving of $3.4 million and a health benefit of 156 QALYs. Among 65-year-old patients, the corresponding cost savings and health benefit were $1.9 million and 125 QALYs. CONCLUSION There are substantial cost and health implications in achieving complete vs incomplete reperfusion after EVT. Our study provides a framework to assess the cost-benefit analysis of emerging diagnostic and therapeutic techniques that might improve patient selection, and increase the chances of achieving complete reperfusion.
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Affiliation(s)
- Xiao Wu
- Department of Radiology and Biomedical Imaging, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Mihir Khunte
- Department of Radiology and Biomedical Imaging, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Dheeraj Gandhi
- Interventional Neuroradiology, University of Maryland, Baltimore, Maryland, USA
| | - Charles Matouk
- Neurosurgery, Yale University, New Haven, Connecticut, USA
| | - Danny R Hughes
- Harvey L Neiman Health Policy Institute, Reston, Virginia, USA
| | - Pina Sanelli
- Hofstra Northwell School of Medicine at Hofstra University, Hempstead, New York, USA
| | - Ajay Malhotra
- Department of Radiology and Biomedical Imaging, Yale University School of Medicine, New Haven, Connecticut, USA
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Cronan J, Horný M, Duszak R, Newsome J, Carlos R, Hughes DR, Memula S, Kokabi N. Invasive Procedural Treatments for Symptomatic Uterine Fibroids: A Cost Analysis. J Am Coll Radiol 2020; 17:1237-1244. [PMID: 32360526 DOI: 10.1016/j.jacr.2020.03.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Revised: 03/06/2020] [Accepted: 03/15/2020] [Indexed: 11/19/2022]
Abstract
PURPOSE The aim of this study was to evaluate the contemporary use of procedural interventions to treat symptomatic uterine fibroids and assess associated health care system costs. METHODS Using the IBM Watson MarketScan Commercial Claims and Encounters database for 2009 to 2015 and relevant International Classification of Diseases diagnosis codes, women aged 18 to 55 years with clinically significant uterine fibroids were identified. Using Current Procedural Terminology codes, relevant procedural interventions were identified (hysterectomy, endometrial ablation, myomectomy, and uterine fibroid embolization [UFE]). Costs were defined as total actual payments by insurers and patients (per procedure and per episode of care) and were adjusted and compared using generalized linear models. RESULTS Of 241,757 invasive procedures for fibroids, hysterectomy was most common (76.5%), followed by endometrial ablation (14.5%), myomectomy (4.7%), and UFE (4.3%). Hysterectomy was more common in older women and those in rural areas (65.2% of patients <40 years of age, 77.6% of those 40-49 years of age, and 83.6% of those 50-55 years of age; 83.9% of patients outside versus 75.3% within metropolitan statistical areas). Per procedure, adjusted mean costs were $3,188 (95% confidence interval [CI], $3,114-$3,264) for hysterectomy, $2,781 (95% CI, $2,695-$2,870) for ablation, $4,436 (95% CI, $4,256-$4,623) for myomectomy, and $6,161 (95% CI, $5,736-$6,617) for UFE. Adjusted mean costs for entire episodes of care were $14,676 (95% CI, $14,496-$14,858) for hysterectomy, $6,702 (95% CI, $6,534-$6,875) for endometrial ablation, $14,791 (95% CI, $14,465-$15,125) for myomectomy, and $13,873 (95% CI, $13,182-$14,599) for UFE. CONCLUSIONS Of invasive procedures for symptomatic uterine fibroids, hysterectomy was used more frequently than endometrial ablation, myomectomy, and UFE combined. Per procedure and per episode, ablation was least costly. Costs per episode were similar for hysterectomy, myomectomy, and UFE.
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Affiliation(s)
- Julie Cronan
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia
| | - Michal Horný
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia; Department of Health Policy and Management, Emory University Rollins School of Public Health, Atlanta, Georgia
| | - Richard Duszak
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia
| | - Janice Newsome
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia
| | - Ruth Carlos
- Department of Radiology, University of Michigan School of Medicine, Ann Arbor, Michigan
| | - Danny R Hughes
- Health Economics and Analytics Lab, School of Economics, Georgia Institute of Technology, Atlanta, Georgia
| | - Savitha Memula
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia
| | - Nima Kokabi
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia.
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French RJ, Rosman DA, Tailor TD, Hemingway J, Hughes DR, Duszak R, Rosenkrantz AB. Changes in Current Procedural Terminology Coding and Its Effect on Specialty-Level Utilization of Musculoskeletal Ultrasound. Curr Probl Diagn Radiol 2020; 50:337-343. [PMID: 32220538 DOI: 10.1067/j.cpradiol.2020.02.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Revised: 01/12/2020] [Accepted: 02/25/2020] [Indexed: 11/22/2022]
Abstract
PURPOSE Concerns regarding increasing utilization of non-vascular extremity ultrasound (US) imaging led to the Current Procedural Terminology (CPT) Editorial Panel separating a singular billing code into distinct comprehensive and focused examination codes with differential reimbursement. We explore this policy change's temporal association with utilization. METHODS Using Physician/Supplier Procedure Summary Master Files, we identified all nonvascular extremity US services billed for Medicare fee-for-service beneficiaries between 1994 and 2017. These included generic (CPT code 76880 from 1994 to 2010), complete (code 76881 from 2011 to 2017), and limited (code 76882 from 2011 to 2017) examinations. Annual utilization per 100,000 beneficiaries was computed and stratified by billing specialty. Compound annual growth rates were calculated. RESULTS Radiologists and podiatrists were the top 2 billing specialties for nonvascular extremity US examinations. From 1994 to 2010, radiologist services increased 6.1% annually. Following the 2011 code separation, radiologists' utilization increased 2.7% annually for complete and 12.3% for limited exams. Between 1994 and 2017, radiologists' market share decreased 72.8% to 40.4%. From 1994 to 2010, podiatrist services increased 87.1% annually. Following the code separation, podiatrists' annual utilization growth stabilized 0.4% for complete and 0.6% for limited exams. Podiatrists' market share was 9.1% in 2001, peaked at 31.3% in 2009, and declined to 14.3% in 2017. CONCLUSIONS Prior rapid growth in extremity nonvascular US for podiatrists slowed considerably following CPT code separation in 2011. Subsequent service growth has largely been related to less costly, focused examinations performed by radiologists. Further study may help better understand how CPT coding changes alter imaging utilization more broadly.
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Affiliation(s)
| | - David A Rosman
- Department of Radiology, Massachusetts General Hospital, Boston, MA
| | - Tina D Tailor
- Department of Radiology, Duke Health System, Durham, NC
| | | | - Danny R Hughes
- Harvey L. Neiman Health Policy Institute, Reston, VA; School of Economics, Georgia Institute of Technology, Atlanta, GA
| | - Richard Duszak
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, GA
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Wu X, Hughes DR, Gandhi D, Matouk CC, Sheth K, Schindler J, Wira C, Wintermark M, Sanelli P, Malhotra A. CT Angiography for Triage of Patients with Acute Minor Stroke: A Cost-effectiveness Analysis. Radiology 2020; 294:580-588. [DOI: 10.1148/radiol.2019191238] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Eberth JM, Ersek JL, Terry LM, Bills SE, Chintanippu N, Carlos R, Hughes DR, Studts JL. Leveraging the Mammography Setting to Raise Awareness and Facilitate Referral to Lung Cancer Screening: A Qualitative Analysis. J Am Coll Radiol 2020; 17:960-969. [PMID: 32112723 DOI: 10.1016/j.jacr.2020.02.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Revised: 01/31/2020] [Accepted: 02/01/2020] [Indexed: 01/04/2023]
Abstract
PURPOSE Despite compelling support for the benefits of low-dose CT (LDCT) screening for lung cancer among high-risk individuals, awareness of LDCT screening and uptake remain low. The aim of this project was to explore the perspectives of ACR mammography screening program directors (MPDs) regarding efforts to raise LDCT screening awareness and appropriate referrals by identifying high-risk individuals participating in routine mammography. METHODS MPDs were recruited from ACR-accredited mammography facilities to participate in semistructured interviews after the completion of an online survey. Interviews were conducted over the telephone, recorded, transcribed, and subsequently reviewed for accuracy. Twenty MPDs were interviewed, and 18 interviews were transcribed and included in the thematic analysis. A theme codebook was developed, and all interviews were coded using NVivo by two trained reviewers. RESULTS Key themes were organized into four broad domains: (1) general attitudes toward the integration of LDCT screening, (2) identifying mammography patients at high risk for lung cancer, (3) counseling about LDCT screening, and (4) strategies to identify high-risk women and increase awareness and knowledge of LDCT screening. Overall, MPDs recognized the benefits of integrating mammography and LDCT screening and were receptive to educating and referring women for LDCT screening. However, training and workflow changes are needed to ensure successful implementation. CONCLUSIONS Qualitative data suggest that MPDs are amenable to leveraging the mammography setting to engage women about LDCT screening; however, additional tools, training, and/or staffing may be necessary to leverage the full potential of reaching women at high risk for lung cancer within the context of mammographic screening.
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Affiliation(s)
- Jan M Eberth
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina; Cancer Prevention and Control Program, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina; Director, Rural and Minority Health Research Center, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina.
| | | | - Leah M Terry
- Department of Behavioral Science, College of Medicine, University of Kentucky, Lexington, Kentucky
| | - Sarah E Bills
- Department of Psychology, University of South Carolina, Columbia, South Carolina
| | | | - Ruth Carlos
- Department of Radiology, Division of Abdominal Radiology, University of Michigan, Ann Arbor, Michigan
| | - Danny R Hughes
- School of Economics, Georgia Institute of Technology, Atlanta, Georgia; Harvey L. Neiman Health Policy Institute, American College of Radiology, Reston, Virginia
| | - Jamie L Studts
- Professor, Division of Medical Oncology, Department of Medicine, University of Colorado School of Medicine; Scientific Director, Behavioral Oncology, Division of Medical Oncology, Department of Medicine, University of Colorado School of Medicine; Interim Program Leader, Cancer Prevention and Control Program, University of Colorado Cancer, Denver, Colorado
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Guichet PL, Duszak R, Chaves Cerdas L, Hughes DR, Hindman N, Rosenkrantz AB. Changing National Medicare Utilization of Catheter, Computed Tomography, and Magnetic Resonance Extremity Angiography: A Specialty-focused 16-Year Analysis. Curr Probl Diagn Radiol 2020; 50:308-314. [PMID: 32029351 DOI: 10.1067/j.cpradiol.2020.01.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Revised: 11/23/2019] [Accepted: 01/06/2020] [Indexed: 11/22/2022]
Abstract
To assess changing utilization of extremity angiography from 2001 to 2016, focusing on modalities and provider specialties. Medicare PSPS Master Files from 2001-2016 and POSPUF from 2016 were used to determine overall and specialty utilization of diagnostic catheter angiography (DCA), CT angiography (CTA), and MR angiography (MRA). From 2001 to 2016, extremity angiography increased from 1107 to 1590 extremities imaged per 100,000 beneficiaries, with rapid expansion of CTA (22 in 2001 to 619 in 2009; plateau of 645 in 2016), but declines in DCA (1039 to 914) and MRA (45 to 30). Over time, extremity angiography shifted from 94% DCA, 4% MRA, and 2% CTA to 58% DCA, 41% CTA, and 2% MRA. For radiologists, extremity angiography increased slightly (741 to 767) with increases in CTA (20 to 595) and large decreases in DCA (681 to 145), with MRA remaining low (40 to 27). Extremity angiography increased for cardiologists (197 to 349) and vascular surgeons (87 to 351), both overwhelmingly performing DCA. Radiologists' share of all extremity angiography shifted from 67% to 48%, with interventionalists (47%), generalists (43%), and abdominal radiologists (7.4%) providing most radiologist services in 2016. Throughout, radiologists were the dominant providers of CTA (89% to 92%) and MRA (89% to 90%). Extremity angiography utilization in Medicare beneficiaries increased nearly 50% from 2001 to 2016, largely related to CTA performed by radiologists. Of radiologists, interventionalists and generalists together render most services. Cardiologists and surgeons assumed a large share of DCA previously performed by radiologists.
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Affiliation(s)
| | - Richard Duszak
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, GA
| | | | - Danny R Hughes
- Harvey L. Neiman Health Policy Institute, Reston, VA; School of Economics, Georgia Institute of Technology, Atlanta, GA
| | - Nicole Hindman
- Department of Radiology, NYU Langone Health, New York, NY
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Yeung H, Baranowski ML, Swerlick RA, Chen SC, Hemingway J, Hughes DR, Duszak R. Use and Cost of Actinic Keratosis Destruction in the Medicare Part B Fee-for-Service Population, 2007 to 2015. JAMA Dermatol 2019; 154:1281-1285. [PMID: 30326488 DOI: 10.1001/jamadermatol.2018.3086] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Importance Actinic keratosis is prevalent and has the potential to progress to keratinocyte carcinoma. Changes in the use and costs of actinic keratosis treatment are not well understood in the aging population. Objective To evaluate trends in the use and costs of actinic keratosis destruction in Medicare patients. Design, Setting, and Participants A billing claims analysis was performed of the Medicare Part B Physician/Supplier Procedure Summary Master Files and National Summary Data of premalignant skin lesion destructions performed from 2007 to 2015 among Medicare Part B fee-for-service beneficiaries. Main Outcomes and Measures Mean number of actinic keratosis lesions destroyed and associated treatment payments in 2015 US dollars estimated per 1000 Medicare Part B fee-for-service beneficiaries. Data analysis was performed from November 2017 to July 2018. Results More than 35.6 million actinic keratosis lesions were treated in 2015, increasing from 29.7 million in 2007. Treated actinic keratosis lesions per 1000 beneficiaries increased from 917 in 2007 to 1051 in 2015, while mean inflation-adjusted payments per 1000 patients decreased from $11 749 to $10 942 owing to reimbursement cuts. The proportion of actinic keratosis lesions treated by independently billing nurse practitioners and physician assistants increased from 4.0% in 2007 to 13.5% in 2015. Conclusions and Relevance This study's findings suggest that actinic keratosis imposes continuously increasing levels of treatment burden in the Medicare fee-for-service population. Reimbursement decreases have been used to control rising costs of actinic keratosis treatment. Critical research may be warranted to optimize access to actinic keratosis treatment and value for prevention of keratinocyte carcinoma.
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Affiliation(s)
- Howa Yeung
- Department of Dermatology, Emory University School of Medicine, Atlanta, Georgia
| | - Marissa L Baranowski
- Department of Dermatology, Emory University School of Medicine, Atlanta, Georgia
| | - Robert A Swerlick
- Department of Dermatology, Emory University School of Medicine, Atlanta, Georgia.,Division of Dermatology, Atlanta Veterans Affairs Medical Center, Decatur, Georgia
| | - Suephy C Chen
- Department of Dermatology, Emory University School of Medicine, Atlanta, Georgia.,Division of Dermatology, Atlanta Veterans Affairs Medical Center, Decatur, Georgia
| | | | - Danny R Hughes
- Harvey L. Neiman Health Policy Institute, Reston, Virginia.,School of Economics, Georgia Institute of Technology Ivan Allen College of Liberal Arts, Atlanta
| | - Richard Duszak
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia
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Gottumukkala RV, Prabhakar AM, Hemingway J, Hughes DR, Duszak R. Disparities over Time in Volume, Day of the Week, and Patient Complexity between Paracentesis and Thoracentesis Procedures Performed by Radiologists versus Those Performed by Nonradiologists. J Vasc Interv Radiol 2019; 30:1769-1778.e1. [PMID: 31422023 DOI: 10.1016/j.jvir.2019.04.015] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Revised: 04/01/2019] [Accepted: 04/11/2019] [Indexed: 11/27/2022] Open
Abstract
PURPOSE To compare the disparities between the paracenteses and thoracenteses performed by radiologists with those performed by nonradiologists over time. Variables included the volume of procedures, the days of the week, and the complexity of the patient's condition. MATERIALS AND METHODS Using carrier claims files for a 5% national sample of Medicare beneficiaries from 2004 to 2016, paracentesis and thoracentesis examinations were retrospectively classified by physician specialty (radiologist vs nonradiologist), day of the week (weekday vs weekend), and the complexity of the patient's condition (using Charlson comorbidity index scores). The Pearson chi-square and independent samples t-test were used for statistical analysis. RESULTS Between 2004 and 2016, the proportion of all paracentesis and thoracentesis procedures performed by radiologists increased from 70% to 80% and from 47% to 66%, respectively. Although radiologists increasingly performed more of both services on both weekends and weekdays, the share performed by radiologists was lower on weekends. For most of the first 9 years across the study period, radiologists performed paracentesis in patients with more complex conditions than those treated by nonradiologists, but the complexity of patients' conditions was similar during recent years. For thoracentesis, the complexity of patients' conditions was similar for both specialty groups across the study period. CONCLUSIONS The proportion of paracentesis and thoracentesis procedures performed in Medicare beneficiaries by radiologists continues to increase, with radiologists increasingly performing most of both services on weekends. Nonetheless, radiologists perform disproportionately more on weekdays than on weekends. Presently, radiologists and nonradiologists perform paracentesis and thoracentesis procedures in patients with similarly complex conditions. These interspecialty differences in timing and complexity of the patient's condition differ from those recently described for several diagnostic imaging services, reflecting the unique clinical and referral patterns for invasive versus diagnostic imaging services.
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Affiliation(s)
- Ravi V Gottumukkala
- Department of Radiology, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114.
| | - Anand M Prabhakar
- Department of Radiology, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114
| | | | - Danny R Hughes
- Harvey L. Neiman Health Policy Institute, Reston, Virginia; School of Economics, Georgia Institute of Technology, Atlanta, Georgia; Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia
| | - Richard Duszak
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia
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Fleming MM, Hughes DR, Golding LP, McGinty GB, MacFarlane D, Duszak R. Digital Breast Tomosynthesis Implementation: Considerations for Emerging Breast Cancer Screening Bundled Payment Models. J Am Coll Radiol 2019; 16:902-907. [DOI: 10.1016/j.jacr.2018.11.025] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2018] [Accepted: 11/22/2018] [Indexed: 10/27/2022]
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Rosenkrantz AB, Hawkins CM, Deitte LA, Hemingway J, Hughes DR, Duszak R. Invasive Procedural Versus Diagnostic Imaging and Clinical Services Rendered by Radiology Trainees Over Two Decades. J Am Coll Radiol 2019; 16:845-855. [DOI: 10.1016/j.jacr.2018.11.029] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2018] [Revised: 11/20/2018] [Accepted: 11/22/2018] [Indexed: 11/25/2022]
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Chiarello MA, Duszak R, Hemingway J, Hughes DR, Patel A, Rosenkrantz AB. Transcatheter Dialysis Conduit Procedures: Changing National and State-Level Medicare Use Patterns over 15 Years. J Vasc Interv Radiol 2019; 30:1050-1056.e3. [PMID: 31133451 DOI: 10.1016/j.jvir.2019.03.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Revised: 02/28/2019] [Accepted: 03/06/2019] [Indexed: 10/26/2022] Open
Abstract
PURPOSE To evaluate the changing use of transcatheter hemodialysis conduit procedures. METHODS Multiple Centers for Medicare & Medicaid Services datasets were used to assess hemodialysis conduit angiography. Use was normalized per 100,000 beneficiaries and stratified by specialty and site of service. RESULTS From 2001 to 2015, hemodialysis angiography use increased from 385 to 1,045 per 100,000 beneficiaries (compound annual growth rate [CAGR], +7.4%)]. Thrombectomy use increased from 114 to 168 (CAGR, +2.8%). Angiography and thrombectomy changed, by specialty, +1.5% and -1.3% for radiologists, +18.4% and +14.4% for surgeons, and +24.0% and +17.7% for nephrologists, respectively. By site, angiography and thrombectomy changed +29.1% and +20.7% for office settings and +0.8% and -2.4% for hospital settings, respectively. Radiologists' angiography and thrombectomy market shares decreased from 81.5% to 37.0% and from 84.2% to 47.3%, respectively. Angiography use showed the greatest growth for nephrologists in the office (from 5 to 265) and the greatest decline for radiologists in the hospital (299 to 205). Across states in 2015, there was marked variation in the use of angiography (0 [Wyoming] to 1173 [Georgia]) and thrombectomy (0 [6 states] to 275 [Rhode Island]). Radiologists' angiography and thrombectomy market shares decreased in 48 and 31 states, respectively, in some instances dramatically (eg, angiography in Nevada from 100.0% to 6.7%). CONCLUSIONS Dialysis conduit angiography use has grown substantially, more so than thrombectomy. This growth has been accompanied by a drastic market shift from radiologists in hospitals to nephrologists and surgeons in offices. Despite wide geographic variability nationally, radiologist market share has declined in most states.
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Affiliation(s)
- Matthew A Chiarello
- Department of Radiology, New York University Langone Health, 660 First Avenue, 3(rd) Floor, New York, NY 10016.
| | - Richard Duszak
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia
| | | | - Danny R Hughes
- Harvey L. Neiman Health Policy Institute, Reston, Virginia; School of Economics, Georgia Institute of Technology, Atlanta, Georgia
| | - Amish Patel
- Department of Radiology, New York University Langone Health, 660 First Avenue, 3(rd) Floor, New York, NY 10016
| | - Andrew B Rosenkrantz
- Department of Radiology, New York University Langone Health, 660 First Avenue, 3(rd) Floor, New York, NY 10016
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Chen MM, Hirsch JA, Lee RK, Hughes DR, Nicola GN, Rosenkrantz AB. Determining the Patient Complexity of Head CT Examinations: Implications for Proper Valuation of a Critical Imaging Service. Curr Probl Diagn Radiol 2019; 49:177-181. [PMID: 31160096 DOI: 10.1067/j.cpradiol.2019.05.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2019] [Revised: 04/05/2019] [Accepted: 05/07/2019] [Indexed: 11/22/2022]
Abstract
PURPOSE The head-computed tomography (CT) exam code was recently identified by policy makers as having a potentially overvalued resource value units (RVU). A critical aspect in determining RVUs is the complexity of patients undergoing the service. This study evaluated the complexity of patients undergoing head-CT. METHODS The 2017 Medicare PSPS Master File was used to identify the most common site for performing head-CT examinations. Given the most common location, the 5% Research Identifiable File, was then used to evaluate complexity of patients undergoing head CT on the same day as an emergency department (ED) visit based on the Evaluation & Management (E&M) "level" of these visits (1-least complex to 5-most complex patient) and the ICD-10 diagnosis coding associated with the billed head CT claims. RESULTS 56.1% of head CT examinations were performed in the ED. Seventy percent of noncontrast exams performed in the ED were ordered in the most complex patient encounters (level 5 E&M visits). The most common ICD-10 code for head-CT without intravenous contrast billed with a level 5 E&M visit was "dizziness and giddiness," and for head-CT without and with intravenous contrast was "headache." CONCLUSION Head-CT is not only most frequently ordered in the ED, but also during the most complex ED visits, suggesting that the ICD-10 codes associated with such exams do not appropriately reflects patient complexity. The valuation process should also consider the complexity of associated billed patient encounters, as indicated by E&M visit levels.
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Affiliation(s)
| | | | - Ryan K Lee
- Thomas Jefferson University, Philadelphia, PA
| | - Danny R Hughes
- Georgia Institute of Technology, Atlanta, GA.; Harvey L. Neiman Health Policy Institute, Reston, VA
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Malhotra A, Wu X, Forman HP, Matouk CC, Hughes DR, Gandhi D, Sanelli P. Management of Unruptured Intracranial Aneurysms in Older Adults: A Cost-effectiveness Analysis. Radiology 2019; 291:411-417. [PMID: 30888931 DOI: 10.1148/radiol.2019182353] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Background Unruptured intracranial aneurysms (UIAs) are relatively common and are being increasingly diagnosed, with a significant proportion in older patients (˃ 65 years old). Serial imaging is often performed to assess change in size or morphology of UIAs since growing aneurysms are known to be at high risk for rupture. However, the frequency and duration of surveillance imaging have not been established. Purpose To evaluate the cost-effectiveness of routine treatment (aneurysm coil placement) versus four different strategies for imaging surveillance of UIAs in adults older than 65 years. Materials and Methods A Markov decision-analytic model was constructed from a societal perspective. Age-dependent input parameters were obtained from published literature. Analysis included adults older than 65 years, with incidental detection of UIA and no prior history of subarachnoid hemorrhage. Five different management strategies for UIAs in older adults were evaluated: (a) annual MR angiography, (b) biennial MR angiography, (c) MR angiography every 5 years, (d) coil placement and follow-up, and (e) limited MR angiography follow-up for the first 2 years after detection only. Outcomes were assessed in terms of quality-adjusted life-years (QALYs). Probabilistic, one-way, and two-way sensitivity analyses were performed. Results Imaging follow-up for the first 2 years after detection is the most cost-effective strategy (cost = $24 572, effectiveness = 13.73 QALYs), showing the lowest cost and highest effectiveness. The conclusion remains robust in probabilistic and one-way sensitivity analyses. Time-limited imaging follow-up remains the optimal strategy when the annual growth rate and rupture risk of growing aneurysms are varied. If annual rupture risk of nongrowing aneurysms is greater than 7.1%, coil placement should be performed directly. Conclusion Routine preventive treatment or periodic, indefinite imaging follow-up is not a cost-effective strategy in all adults older than 65 years with unruptured intracranial aneurysms. More aggressive management strategies should be reserved for patients with high risk of rupture, such as those with aneurysms larger than 7 mm and those with aneurysms in the posterior circulation. © RSNA, 2019 Online supplemental material is available for this article. See also the editorial by Cloft in this issue.
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Affiliation(s)
- Ajay Malhotra
- From the Departments of Radiology and Biomedical Imaging (A.M., X.W., H.P.F., C.C.M.), Economics (H.P.F.), Management (H.P.F.), Public Health (H.P.F.), and Neurosurgery (C.C.M.), Yale School of Medicine, 333 Cedar St, Box 208042, Tompkins East 2, New Haven, CT 06520-8042; Harvey L. Neiman Health Policy Institute, Reston, VA (D.R.H.); Department of Radiology, University of Maryland School of Medicine, Baltimore, MD (D.G.); and Department of Radiology, Northwell Health, Manhasset, NY (P.S.)
| | - Xiao Wu
- From the Departments of Radiology and Biomedical Imaging (A.M., X.W., H.P.F., C.C.M.), Economics (H.P.F.), Management (H.P.F.), Public Health (H.P.F.), and Neurosurgery (C.C.M.), Yale School of Medicine, 333 Cedar St, Box 208042, Tompkins East 2, New Haven, CT 06520-8042; Harvey L. Neiman Health Policy Institute, Reston, VA (D.R.H.); Department of Radiology, University of Maryland School of Medicine, Baltimore, MD (D.G.); and Department of Radiology, Northwell Health, Manhasset, NY (P.S.)
| | - Howard P Forman
- From the Departments of Radiology and Biomedical Imaging (A.M., X.W., H.P.F., C.C.M.), Economics (H.P.F.), Management (H.P.F.), Public Health (H.P.F.), and Neurosurgery (C.C.M.), Yale School of Medicine, 333 Cedar St, Box 208042, Tompkins East 2, New Haven, CT 06520-8042; Harvey L. Neiman Health Policy Institute, Reston, VA (D.R.H.); Department of Radiology, University of Maryland School of Medicine, Baltimore, MD (D.G.); and Department of Radiology, Northwell Health, Manhasset, NY (P.S.)
| | - Charles C Matouk
- From the Departments of Radiology and Biomedical Imaging (A.M., X.W., H.P.F., C.C.M.), Economics (H.P.F.), Management (H.P.F.), Public Health (H.P.F.), and Neurosurgery (C.C.M.), Yale School of Medicine, 333 Cedar St, Box 208042, Tompkins East 2, New Haven, CT 06520-8042; Harvey L. Neiman Health Policy Institute, Reston, VA (D.R.H.); Department of Radiology, University of Maryland School of Medicine, Baltimore, MD (D.G.); and Department of Radiology, Northwell Health, Manhasset, NY (P.S.)
| | - Danny R Hughes
- From the Departments of Radiology and Biomedical Imaging (A.M., X.W., H.P.F., C.C.M.), Economics (H.P.F.), Management (H.P.F.), Public Health (H.P.F.), and Neurosurgery (C.C.M.), Yale School of Medicine, 333 Cedar St, Box 208042, Tompkins East 2, New Haven, CT 06520-8042; Harvey L. Neiman Health Policy Institute, Reston, VA (D.R.H.); Department of Radiology, University of Maryland School of Medicine, Baltimore, MD (D.G.); and Department of Radiology, Northwell Health, Manhasset, NY (P.S.)
| | - Dheeraj Gandhi
- From the Departments of Radiology and Biomedical Imaging (A.M., X.W., H.P.F., C.C.M.), Economics (H.P.F.), Management (H.P.F.), Public Health (H.P.F.), and Neurosurgery (C.C.M.), Yale School of Medicine, 333 Cedar St, Box 208042, Tompkins East 2, New Haven, CT 06520-8042; Harvey L. Neiman Health Policy Institute, Reston, VA (D.R.H.); Department of Radiology, University of Maryland School of Medicine, Baltimore, MD (D.G.); and Department of Radiology, Northwell Health, Manhasset, NY (P.S.)
| | - Pina Sanelli
- From the Departments of Radiology and Biomedical Imaging (A.M., X.W., H.P.F., C.C.M.), Economics (H.P.F.), Management (H.P.F.), Public Health (H.P.F.), and Neurosurgery (C.C.M.), Yale School of Medicine, 333 Cedar St, Box 208042, Tompkins East 2, New Haven, CT 06520-8042; Harvey L. Neiman Health Policy Institute, Reston, VA (D.R.H.); Department of Radiology, University of Maryland School of Medicine, Baltimore, MD (D.G.); and Department of Radiology, Northwell Health, Manhasset, NY (P.S.)
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Fukuda T, Hughes DR, Schweitzer ME. Value of MRI in changing of diabetic foot osteomyelitis management. J Magn Reson Imaging 2019; 49:e300-e301. [PMID: 30618124 DOI: 10.1002/jmri.26625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Revised: 12/05/2018] [Accepted: 12/06/2018] [Indexed: 11/08/2022] Open
Affiliation(s)
- Takeshi Fukuda
- Department of Radiology, Stony Brook University, Stony Brook, New York, USA
| | - Danny R Hughes
- Harvey L. Neiman Health Policy Institute, Reston, Virginia, USA.,School of Economics, Georgia Institute of Technology, Atlanta, Georgia, USA
| | - Mark E Schweitzer
- Department of Radiology, Stony Brook University, Stony Brook, New York, USA
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Sharp PE, Lall NU, Hughes DR, Harkey PP, Duszak R. Characteristics of MR Neuroimaging Services Billed by Radiologists versus Nonradiologists. AJNR Am J Neuroradiol 2018; 39:1975-1980. [PMID: 30262642 DOI: 10.3174/ajnr.a5807] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Accepted: 07/25/2018] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Although most neuroimaging examinations are interpreted by radiologists, many nonradiologists provide interpretation services. We studied day of the week, site of service, and patient complexity differences for common Medicare MR neuroimaging examinations interpreted by radiologists versus nonradiologists. MATERIALS AND METHODS Using carrier claims files for a 5% sample of Medicare beneficiaries from 2012 to 2014, we identified all claims for brain and lumbar spine MR imaging examinations. Services were categorized by physician specialty, day of the week, and the site of service. Patient complexity was calculated using Charlson Comorbidity Indices. The χ2 was performed to test statistical significance. RESULTS A provider specialty could be identified for 568,423 brain and lumbar spine MR imaging examinations. Of weekday examinations, radiologists interpreted 475,288 (92.3%), and nonradiologists, 39,510 (7.7%). Of weekend examinations, radiologists interpreted 52,028 (97.0%) and nonradiologists 1597 (3.0%). Radiologists interpreted 145,904 (98.7%) examinations in the inpatient hospital and emergency department settings versus 1882 (1.3%) by nonradiologists. Of all examinations, 44,547 of those interpreted by radiologists (8.4%) were on the most clinically complex patients versus 2139 (5.2%) for nonradiologists. All interspecialty differences for day of the week, the site of service, and patient complexity were statistically significant (P < .001). CONCLUSIONS Although radiologists interpret most common MR neuroimaging examinations for Medicare beneficiaries, in contrast to nonradiologists, they disproportionately render those services on weekends, in higher acuity sites, and on more complex patients. To optimize access and minimize disparities in necessary neuroimaging, quality metrics should consider such service characteristics.
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Affiliation(s)
- P E Sharp
- From the Department of Radiology and Imaging Sciences (P.E.S., P.P.H., R.D.), Emory University School of Medicine, Atlanta, Georgia
| | - N U Lall
- Department of Radiology (N.U.L.), Ochsner Health System, New Orleans, Louisiana
| | - D R Hughes
- Neiman Health Policy Institute (D.R.H.), Reston, Virginia.,School of Economics (D.R.H.), Georgia Institute of Technology, Atlanta, Georgia
| | - P P Harkey
- From the Department of Radiology and Imaging Sciences (P.E.S., P.P.H., R.D.), Emory University School of Medicine, Atlanta, Georgia
| | - R Duszak
- From the Department of Radiology and Imaging Sciences (P.E.S., P.P.H., R.D.), Emory University School of Medicine, Atlanta, Georgia
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Rosenkrantz AB, Hughes DR, Duszak R. Authors’ Reply. J Am Coll Radiol 2018; 15:1205. [DOI: 10.1016/j.jacr.2018.06.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2018] [Accepted: 06/21/2018] [Indexed: 11/26/2022]
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Morris E, Duszak R, Sista AK, Hemingway J, Hughes DR, Rosenkrantz AB. National Trends in Inferior Vena Cava Filter Placement and Retrieval Procedures in the Medicare Population Over Two Decades. J Am Coll Radiol 2018; 15:1080-1086. [DOI: 10.1016/j.jacr.2018.04.024] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2018] [Revised: 04/10/2018] [Accepted: 04/23/2018] [Indexed: 11/30/2022]
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Rosenkrantz AB, Hemingway J, Hughes DR, Duszak R, Allen B, Weinreb JC. Evolving Use of Prebiopsy Prostate Magnetic Resonance Imaging in the Medicare Population. J Urol 2018; 200:89-94. [DOI: 10.1016/j.juro.2018.01.071] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/13/2018] [Indexed: 10/18/2022]
Affiliation(s)
- Andrew B. Rosenkrantz
- Department of Radiology, New York University Langone Medical Center, New York, New York
| | | | - Danny R. Hughes
- Harvey L. Neiman Health Policy Institute, Reston, Virginia
- School of Economics, Georgia Institute of Technology, Atlanta, Georgia
| | - Richard Duszak
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia
| | - Bibb Allen
- Department of Radiology, Grandview Medical Center, Birmingham, Alabama
| | - Jeffrey C. Weinreb
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, Connecticut
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Kang SK, Jiang M, Duszak R, Heller SL, Hughes DR, Moy L. Use of Breast Cancer Screening and Its Association with Later Use of Preventive Services among Medicare Beneficiaries. Radiology 2018; 288:660-668. [PMID: 29869958 DOI: 10.1148/radiol.2018172326] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Purpose To retrospectively assess whether there is an association between screening mammography and the use of a variety of preventive services in women who are enrolled in Medicare. Materials and Methods U.S. Medicare claims from 2010 to 2014 Research Identifiable Files were reviewed to retrospectively identify a group of women who underwent screening mammography and a control group without screening mammography in 2012. The screened group was divided into positive versus negative results at screening, and the positive subgroup was divided into false-positive and true-positive findings. Multivariate logistic regression models and inverse probability of treatment weighting were used to examine the relationship between screening status and the probabilities of undergoing Papanicolaou test, bone mass measurement, or influenza vaccination in the following 2 years. Results The cohort consisted of 555 705 patients, of whom 185 625 (33.4%) underwent mammography. After adjusting for patient demographics, comorbidities, geographic covariates, and baseline preventive care, women who underwent index screening mammography (with either positive or negative results) were more likely than unscreened women to later undergo Papanicolaou test (odds ratio [OR], 1.49; 95% confidence interval: 1.40, 1.58), bone mass measurement (OR, 1.70; 95% confidence interval: 1.63, 1.78), and influenza vaccine (OR, 1.45; 95% confidence interval: 1.37, 1.53). In women who had not undergone these preventive measures in the 2 years before screening mammography, use of these three services after false-positive findings at screening was no different than after true-negative findings at screening. Conclusion In beneficiaries of U.S. Medicare, use of screening mammography was associated with higher likelihood of adherence to other preventive guidelines, without a negative association between false-positive results and cervical cancer screening.
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Affiliation(s)
- Stella K Kang
- From the Department of Radiology, NYU School of Medicine, 550 First Ave, New York, NY 10016 (S.K.K., S.L.H., L.M.); Department of Population Health, NYU Langone Medical Center, New York, NY (S.K.K.); Harvey L. Neiman Health Policy Institute, Reston, Va (M.J., D.R.H.); Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Ga (R.D.); and School of Economics, Georgia Institute of Technology, Atlanda, Ga (D.R.H.)
| | - Miao Jiang
- From the Department of Radiology, NYU School of Medicine, 550 First Ave, New York, NY 10016 (S.K.K., S.L.H., L.M.); Department of Population Health, NYU Langone Medical Center, New York, NY (S.K.K.); Harvey L. Neiman Health Policy Institute, Reston, Va (M.J., D.R.H.); Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Ga (R.D.); and School of Economics, Georgia Institute of Technology, Atlanda, Ga (D.R.H.)
| | - Richard Duszak
- From the Department of Radiology, NYU School of Medicine, 550 First Ave, New York, NY 10016 (S.K.K., S.L.H., L.M.); Department of Population Health, NYU Langone Medical Center, New York, NY (S.K.K.); Harvey L. Neiman Health Policy Institute, Reston, Va (M.J., D.R.H.); Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Ga (R.D.); and School of Economics, Georgia Institute of Technology, Atlanda, Ga (D.R.H.)
| | - Samantha L Heller
- From the Department of Radiology, NYU School of Medicine, 550 First Ave, New York, NY 10016 (S.K.K., S.L.H., L.M.); Department of Population Health, NYU Langone Medical Center, New York, NY (S.K.K.); Harvey L. Neiman Health Policy Institute, Reston, Va (M.J., D.R.H.); Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Ga (R.D.); and School of Economics, Georgia Institute of Technology, Atlanda, Ga (D.R.H.)
| | - Danny R Hughes
- From the Department of Radiology, NYU School of Medicine, 550 First Ave, New York, NY 10016 (S.K.K., S.L.H., L.M.); Department of Population Health, NYU Langone Medical Center, New York, NY (S.K.K.); Harvey L. Neiman Health Policy Institute, Reston, Va (M.J., D.R.H.); Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Ga (R.D.); and School of Economics, Georgia Institute of Technology, Atlanda, Ga (D.R.H.)
| | - Linda Moy
- From the Department of Radiology, NYU School of Medicine, 550 First Ave, New York, NY 10016 (S.K.K., S.L.H., L.M.); Department of Population Health, NYU Langone Medical Center, New York, NY (S.K.K.); Harvey L. Neiman Health Policy Institute, Reston, Va (M.J., D.R.H.); Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Ga (R.D.); and School of Economics, Georgia Institute of Technology, Atlanda, Ga (D.R.H.)
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Rosenkrantz AB, Hoque K, Hemingway J, Hughes DR, Duszak R. Unique Medicare Beneficiaries Served: A Radiologist-Focused Specialty-Level Analysis. J Am Coll Radiol 2018; 15:734-739.e2. [DOI: 10.1016/j.jacr.2018.01.021] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2017] [Accepted: 01/15/2018] [Indexed: 10/17/2022]
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Hughes DR. Can You Do Health Disparities Research with Publicly Available Datasets? Acad Radiol 2018; 25:552-555. [PMID: 29352641 DOI: 10.1016/j.acra.2017.06.019] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2017] [Revised: 06/22/2017] [Accepted: 06/22/2017] [Indexed: 10/18/2022]
Abstract
RATIONALE AND OBJECTIVES Given the growing importance of identifying and reducing health disparities, it is important for radiologist researchers to engage in this space to promote evidence-based imaging disparities policy. However, researchers are often hindered by access to appropriate data to perform quality research. MATERIALS AND METHODS This paper reviews existing publicly available data sets that may be useful for performing imaging disparities research. RESULTS Multiple data sources are publicly available and have been used by previous researchers to examine imaging disparities. CONCLUSIONS This paper provides an overview of publicly available data sources that radiologists can use for imaging disparities research. Appropriate use of these data sources will require researchers to carefully consider the overall research question and level of analysis.
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Rosenkrantz AB, Prologo JD, Wang W, Hughes DR, Bercu ZL, Duszak R. Opioid Prescribing Behavior of Interventional Radiologists Across the United States. J Am Coll Radiol 2018; 15:726-733. [DOI: 10.1016/j.jacr.2018.01.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2017] [Revised: 01/02/2018] [Accepted: 01/03/2018] [Indexed: 10/18/2022]
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