E4809. Nuclear Medicine by the Numbers: What We Can Learn About Our Specialty from the Centers for Medicare and Medicaid Services Database
  1. Corey O'Reilly; San Antonio Military Medical Center
  2. Kevin Banks; San Antonio Military Medical Center; Uniformed Services University
  3. Nathan McWhorter; San Antonio Military Medical Center; Uniformed Services University
  4. Michael Clemenshaw; San Antonio Military Medical Center
  5. Bin Wang; San Antonio Military Medical Center
Publicly available “Medicare Physician and Other Practitioners by Provider and Service” datasets for 2013–2019 were utilized (based on Part B claims data). Medicare is the largest purchaser of health care in the US (21%). Medicare Part B covers most outpatient services and made up 46% of overall Medicare payments in 2018 ($300 billion). The Medicare databases provide information on submitted charges by NPI, CPT code, and place of service, including data on services of more than 695k physicians, including an average of 687 nuclear medicine (NM) physicians and 32,508 radiologists. The dataset was queried by year for all NM CPT codes (78000–79000) and analyzed with subanalyses to determine the highest frequency examinations.

Educational Goals / Teaching Points
1. Review the CMS database and the role of Medicare Part B in healthcare spending. 2. Illustrate the practice of diagnostic NM in the US by specialty. 3. Demonstrate the changes in types and volume NM imaging studies being performed over time. 4. Discuss trends and implications for the future of NM imaging.

Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
Practice of diagnostic nuclear medicine by specialty. Practice of NM in the United States is unique to other diagnostic services due to significant overlap in training between NM, DR, and to a lesser degree, cardiology. This, and other factors, results in examinations being performed by variety of specialists. Most myocardial perfusion scans and cardiac PETs are performed by cardiologists. The majority of all other NM imaging studies are performed by radiologists. As a group, nonradiology, non-NM providers perform the second largest portion of PET-CT and general NM exams. Practice of diagnostic nuclear medicine by volume. Overall, the number of general NM studies being performed annually has declined. Likewise, the number of MPS studies has declined, though partially offset by increasing volume of cardiac PET. PET-CT volume has steadily increased, likely due an increase in availability and clinical indications. PET volume has also increased since 2013, likely due to increased use for neurodegenerative disease.

The practice of NM in the US is changing. Most general NM examinations are being utilized less each year, with a few exceptions such as neurologic and gastrointestinal transit scintigraphy studies. Similarly, the volume of myocardial perfusion examinations is declining, but is being at least partially offset by an increasing number of cardiac PET examinations. In contrast, PET and PET-CT volumes are increasing, likely due to a combination of increased scanner and radiotracer availability as well as expanding clinical indications. These trends suggest that the newest diagnostic tool in the field, PET/PET-CT, is on track to become the most significant aspect of practice within the specialty.