More Than a Quarter of Emergency Radiological Services Uncompensated
Utilization of medical imaging nationwide may be in decline, but its use in the emergency department setting continues to grow—and much of that use is uncompensated, according to a study presented Monday at RSNA 2013.
In his study of a research sample representing an estimated 8 percent of radiologists nationwide, Richard Duszak, Jr., M.D., found radiologists received no compensation at all for 28.4 percent of radiological services rendered to emergency department (ED) patients.
"Given the 'safety net' role of EDs for uninsured patients, uncompensated services are increasingly a challenge to all specialists and appear to be a particularly common problem for radiologists," said Dr. Duszak, chief medical officer of the Harvey L. Neiman Health Policy Institute (HPI) of the American College of Radiology.
The shortfall represents a mean $2,584 per month per physician in Medicare dollars for professional services alone, said Dr. Duszak, incoming vice-chair for Health Policy and Practice in the Department of Radiology and Imaging Services at the Emory University School of Medicine in Atlanta. "As physician reimbursement declines, this volume of uncompensated care could threaten patient access," he said.
Data from 2009 to 2012 were captured by Zotec Partners, a large nationwide radiology billing company. Most commonly rendered services were: one-view and two-view chest radiography (20.8 and 28.3 percent uncompensated, respectively); non-contrast brain CT (26.5 percent uncompensated); and contrast and non-contrast abdomen/pelvis CT (28.8 and 27.6 percent uncompensated, respectively.
Most frequent modalities were radiography (27.4 percent uncompensated); CT (29.1 percent uncompensated) and ultrasound (33.5 percent uncompensated). Although CT represented just a third of ED services, it accounted for nearly two-thirds of uncompensated dollars. Of all uncompensated services, 52.3 percent were rendered to uninsured patients.
"Our findings help to increase the awareness of policymakers and regulators, so that ED patient access to needed radiological services is ensured," Dr. Duszak said.
Order Entry System for Trauma CT Increases Rate of Patient's Clinical History
In another RSNA 2013 study, researchers measured the impact of a structured physician order entry system for trauma CT imaging on the clinical information provided to the radiologist and on associated coding practices and reimbursement success.
The study was conducted between at a quaternary care institution with a Level 1 Trauma Center and 58,000 ED visits annually and comprised 457 patients who received CT pan-scans, including 2,734 distinct exam accessions. After the intervention, there was a 62 percent increase in requisitions containing clinical signs, symptoms, or physical examination findings and a 99 percent increase in provided mechanism of injury.
There was a 19 percent increase in primary ICD-9-CM codes representing clinical signs or symptoms (from 3 percent to 22 percent, p < .0001), and a modest 4 percent increase in reimbursement success for examinations submitted to insurance carriers (from 91 percent to 95 percent, p = .003). Rate of initial reimbursement denials dropped 7 percent (from 24 percent to 17 percent, p = .04).
Results showed that implementation of structured physician order entry for trauma CT imaging was associated with a large increase in rate of clinical history provided to the radiologist and was associated with a decrease in initial reimbursement denials and a modest increase in reimbursement success.