Imaging Costs Prompt OIG Inspections

by Brendon Nafziger, DOTmed News Associate Editor | October 14, 2009

Both houses of Congress, in health care reform bills, are looking to increase assumed utilization rates, too, probably to around 75 percent.

However, these numbers are disputed, and the ACR suggests an OIG investigation could reveal what it believes are the real, lower assumed utilization rates.

"The Radiologist Business Managers Association [recently] did national sampling and discovered the actual utilization rate," Farley says. "And they found it's only 54 percent nationwide, and 48 percent in rural practices."

Farley says the 90 percent number used by CMS comes from a MedPAC survey of large, urban hospitals not representative of most imaging centers, and certainly not small, country ones.

What radiologists can expect

While the odds of an OIG agent showing up at a radiologist's office as part of an investigation are low, it could happen, Farley says. That's why the ACR is advising all radiologists to make sure their books are in order. "We're advising staff to document all exams," Farley says. "Our advice is to keep good records."

As for the increase in imaging costs, Farley says it should be seen in perspective. When the OIG or CMS looks at the costs of imaging rising from 1990 to 2006 -- around 2 percent a year in 2006 and 2007, Farley says, which he claims is in line with most other medical practices -- it's not, he thinks, evidence of something wrong, but of something right: imaging services are safe, accurate alternatives to invasive diagnostic methods.

"In the 1940s and '50s, orders for penicillin grew at a rapid rate -- because it worked," he says. "You can't simply look at growth rates in a vacuum."

Read DOTmed's additional coverage:
OIG to Open New Studies on Medicare Part B Imaging, DME Services

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