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Musculoskeletal CT exams jump 754 percent over 20 years

by John W. Mitchell , Senior Correspondent
Utilization rates for the four most common orthopedic extremity imaging tests among Medicare patients jumped substantially from 1994 to 2013. This, according to a study by the Harvey L. Neiman Health Policy Institute, published in the most recent issue of the American Journal of Roentgenology.

"We were not surprised by these results, as there has been a growing interest and focus on improving musculoskeletal care for patients," Dr. Soterios Gyftopoulos, associate professor of radiology and MSK Imaging Fellowship, director at NYU Langone Orthopedic Center in New York City, told HCB News. "Imaging, especially advanced imaging like MR and ultrasound, can greatly enhance these efforts by providing clinically useful and impactful information that can guide care for this patient population."

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He and his team reviewed master file billing data obtained from the Centers for Medicare and Medicaid Services. The study relied on the NITOS radiology claims classification system criteria. They concluded that over the two decades in the study period that radiography increased 43 percent; ultrasound was up 528 percent; MR jumped 619 percent; and CT was up 754 percent.

According to the study conclusion, during the study period, radiology remained the most common billing specialty (orthopedic surgery was second by about half the volume). Physician offices and hospital outpatient settings were the most common site for the exams. The authors noted that they conducted the study to fill "persistent knowledge gaps" in how advancements in technology impact ordered exam volumes by subspecialties.

Gyftopoulos said that the study could serve as a good tool in making decisions about capital expenditures for imaging technology to meet demand.

"This type of information is useful for hospital administrators and radiology group leaders when they are seeking to improve patient access to their services," he said. The increase in utilization, he added, can potentially be attributed to "increased access to imaging and a greater understanding of its potential impact on musculoskeletal care."

When asked about the impact of the study findings on the pending Appropriate Use Criteria (AUC) program for advanced imaging to commence in 2019, Gyftopoulos was supportive.

"The implementation of the CMC AUC program will enhance the positive benefits of imaging for musculoskeletal conditions by increasing the chances that the right imaging studies are ordered for the appropriate indications," he said.

He also said the study results suggested some caution and possible change in use protocols.

"Payers and accreditation bodies should re-examine technical and performance standards for non-vascular extremity ultrasound imaging, given the potential patient hazards of increased utilization of lower value and lower quality imaging," Gyftopoulos added.

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