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E1281. Utilization Among Medicare Beneficiaries and Trends in Work Relative Value Units (wRVUs) for Common Diagnostic Radiology Studies: 2011-2021
Authors
  1. Derrek Schartz; Department of Imaging Sciences, University of Rochester Medical Center
  2. Emily Schartz; Department of Imaging Sciences, University of Rochester Medical Center
Objective:
The goal of this study was to identify the 50 most commonly performed imaging studies for Medicare beneficiaries based on total allowed services and charges by Medicare. Additionally, an analysis on temporal changes in Work Relative Value Units (wRVUs) for these studies was conducted to investigate its potential influence on Medicare compensation. The overall purpose of this study was to better inform future investigations into Medicare reimbursement for Diagnostic Radiology.

Materials and Methods:
The 2019 Part B National Summary Data File from the Centers for Medicare and Medicaid Services was queried. From this file, the 50 most common radiologic imaging studies were identified by the total amount of allowed services by Medicare, which was used as a surrogate for utilization. The total amount of allowed charges was also investigated. Additionally, the Physician Fee Look-Up Tool from the Center for Medicare and Medicaid Services was used to extract the wRVU data for each study from 2011 to 2021 to assess for changes over time.

Results:
The top 5 most utilized studies were, respectively, chest radiograph 1 view (15.6 x 10^6 allowed services), chest radiograph 2 views (11.5 x 10^6), screening mammography bilateral (6.4 x 10^6), CT head w/o contrast (5.7 x 10^6), and CT abdomen and pelvis w/contrast (3.5 x 10^6). From the top 50 most performed studies, those that had the top 5 highest total allowed charges by Medicare were, respectively, myocardial perfusion SPECT ($475 x 10^6 total allowed charges), screening mammography bilateral ($453 x 10^6), CT abdomen and pelvis w/contrast ($408 x 10^6), CT head w/o contrast ($258 x 10^6), and CT abdomen and pelvis w/o contrast ($234 x 10^6). Assessment of wRVU trends revealed that the mean wRVU per imaging study saw a small decline during the study period, from 0.79 wRVU in 2011 to 0.78 wRVU in 2021 (–1.3%); 34 of 50 studies saw no change in its wRVU amount, whereas eight studies saw a declined and eight studies had an increase in wRVU amount. Limited breast ultrasound had the largest increase in wRVU (+20%), and CT maxillofacial w/o contrast (–25%) experienced the largest decline during the 10-year study period.

Conclusion:
The purpose of this study was to explore and detail diagnostic imaging utilization and Medicare-allowed charges among Medicare beneficiaries. Additionally, wRVU adjustments were investigated and saw a small overall decline during the study period, with most studies experiencing no wRVU changes. The data described here may be used to inform future studies on Medicare reimbursement and utilization for diagnostic radiology. This study suggests that if there are significant alterations in reimbursement for diagnostic imaging, wRVUs may not be the primary contributing component, and that other factors should be investigated.