Utilization of noninvasive diagnostic imaging procedures varies greatly depending on geographic location, according to a study published in the April issue of The American Journal of Roentgenology.

Laurence Parker of Thomas Jefferson University Hospital headed a research team that looked at geographic variation in noninvasive diagnostic imaging in Medicare patients across the country. Researchers found that the Atlanta region held the highest utilization rate, 4.60 procedures per capita, and the Seattle region had the lowest rate, with 2.99 procedures per capita. Cardiovascular and high-technology procedures show the greatest regional variation.

The relative risk, or the ratio of the highest to lowest region, ranged from 1.47 to 1.54 over the 10-year study. This risk is substantial, according to the researchers' paper, because it means one regional population has an excess of 50 percent in utilization over another. In fact, relative risks of 1.2 or greater start drawing attention.
"This concerns you, because you'd think if medical practice is applied the same everywhere you should see similar rates of utilization," Parker tells DOTmed News.

Parker and his team studied the data set from CMS but used only the fee-for-service Medicare population. The study focused on this population because elderly people tend to require these procedures more frequently.

But more important, the 10 data sets from CMS contain the largest amount of information that can be used for this type of study.

"This is the age group that gets a lot of health care services," Parker says. "It's the most costly age group...The Medicare data set is simply the best and largest data set we have...That's a data set of 35 million people."

The purpose of Parker's study is to address radiology because it's an area of interest, due to its tremendous growth and costly procedures.

"Geographic variation in a high-class procedure means that in some areas they are not using much of the [radiology], and there are other areas where they use a lot," explains Parker.

Parker points out the fact that the Atlanta region, which had the highest utilization, includes Florida where there are a lot of health care facilities that treat Medicare patients.

"Given the amount of health care for the elderly in Florida, it's probably the reason that [the] Atlanta [region] comes out on top so often," he says.

But Parker is confident that even looking at a younger population, there would be substantial geographic variation; Florida doesn't affect the results that much.

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