Medicare diagnostic imaging volumes dipped in 2010 after almost a decade of torrid growth, according to a new report from the Medicare Payment Advisory Commission (MedPAC) that confirms the numbers it shared during a policy meeting in December.

MedPAC's report, released Friday, said medical imaging volume per fee-for-service beneficiary fell 2.5 percent from 2009 to 2010, after a cumulative increase of 85 percent from 2000 to 2009.

The group, which consults with Congress about Medicare spending, said the decline happened as criticisms mounted that medical imaging is overused.

"Physicians have voiced concerns about diagnostic tests that are ordered without an understanding of how the results could change patient treatment," the report said. "One test can start a cascade of other more invasive tests or treatments."

MedPAC also said it has commissioned a study, still in progress, to look into how and why doctors order repeat exams. The study's checking out three exam types: chest CTs, echocardiograms and imaging stress tests. "Given the lack of research on this topic, the first aim of the project is to document the extent to which services are repeated at given intervals, such as within one year after an index service," the group said. "But the study is also showing that some clinicians routinely repeat services, even though standards for doing so are lacking."

The group suggested it has found "wide geographic variation" in the frequency of test repeats and that without external standards "local practice styles" seem to determine exam frequencies.

Despite the decline

Despite the 2010 decline, some costly advanced imaging procedures were still being used at almost double the rate they were a decade ago, the group said.

Units of service per beneficiary for non-brain CT scans stood at 548 per 1,000 beneficiaries, down from 551 per 1,000 in 2009, but still twice as high as the 258 per 1,000 rate in 2000, MedPAC said. Similarly, for non-brain MRI scans, the 2010 use rate stood at 141 per 1,000 beneficiaries, down from the 2009 high of 144 per 1,000 beneficiaries, but more than double the 2000 rate, of 64 per 1,000.

Some non-imaging tests -- which, like imaging, had seen explosive growth since the turn of the millennium -- also either showed stagnant growth or a decline. From 2009 to 2010, ECG test volumes increased only one-third of a percent, MedPAC said, while heart stress test volumes dropped a whopping 6.2 percent.

The Medical Imaging and Technology Alliance, or MITA, a medical imaging manufacturers lobby, said the data are consistent with its findings that imaging utilization per Medicare beneficiary declined by 3 percent in 2010, and that Medicare spending on imaging fell 13.2 percent since 2006, when the reimbursement-slashing Deficit Reduction Act went into effect.

"We appreciate MedPAC's attention to the latest payment trends and encourage members of Congress to consider these findings before targeting medical imaging services for additional reimbursement cuts," MITA's executive director Gail Rodriguez said in a statement.

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