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Gut Reactions
ONC Distributes Federal Health IT Plan

Gut Reactions

Study Looks at Link Between Abdominal Imaging Utilization and Self-Referral

Imaging utilization can remain under control if there are fewer opportunities for self-referral, as supported by a study published in the June issue of the Journal of the American College of Radiology (JACR).

In “Recent Trends in Utilization Rates of Abdominal Imaging: The Relative Roles of Radiologists and Nonradiologist Physicians,” study author David C. Levin, MD, with Vijay M. Rao, MD, Laurence Parker, PhD, Andrea J. Frangos, MS, and Jonathan H. Sunshine, PhD, examined the recent utilization of abdominal imaging by comparing Medicare Part B data from both radiologists and nonradiologist physicians.

“Considerable concern has been expressed in recent years about growth in the number of medical services provided by physicians to patients,” the study begins. “Imaging has been shown to be the most rapidly growing of these services, and there is concern that the associated increase in costs is unsustainable in the long term. As a result, payers and policymakers have focused efforts on ways to control imaging growth.”

The researchers pointed to the Centers for Medicare and Medicaid Services’ recent proposed rule for the Medicare 2008 physician fee schedule, which contained a number of approaches for controlling imaging growth—particularly imaging that is self-referred by nonradiologist physicians. Furthermore, last summer the US House of Representatives passed the Children’s Health and Medicare Protection Act, which also addressed the issue of self-referral. The authors say that the current climate mandates an understanding of patterns of utilization and growth trends in different modalities, and an assessment of the role of self-referral.

Using the CMS Physician/Supplier Procedure Summary Master Files for 1996 through 2005 as their data source, the researchers tabulated global and professional-component claims and determined provider specialties by using Medicare’s 108 specialty codes. The team acknowledged that small errors may have been introduced into the determination of which specialty was responsible for a given examination, due to the exclusion of technical-component claims. “Any such errors might underestimate the amount of utilization by nonradiologist physicians, but they would not affect the large majority of studies ….” Also, another area for possible error involved physicians that self-designated their own specialties.

Diagnostic abdominal and pelvic imaging codes were selected and grouped into six categories: CT and CT angiography (CTA); MR and MR angiography; ultrasound of the abdo-men, retroperitoneum, and pelvis; radionuclide imaging; abdominal radiography; and fluoroscopy of the GI tract. Utilization rates per 1,000 Medicare beneficiaries were calculated for all codes and categories.

The overall utilization rate in-creased from 451.9 examinations per 1,000 beneficiaries in 1996 to 564.5 in 2005, representing a modest 25% gain. The research team attributed the increase to the widespread use of advanced imaging modalities, such as CT and CTA, which rose 141% from 99.4 exams in 1996 to 239.3 in 2005. This number was offset by the decreased usage of other modalities, such as plain radiography.

The overall abdominal imaging utilization rate among radiologists increased from 383.3 exams per 1,000 in 1996 to 493.9 in 2005, equaling a 29% increase. This compares to an 11% increase in the utilization rate of nonradiologist physicians, from 51.8 to 57.4. On a pure, numerical basis, the increase among radiologists was much greater, with radiologists’ overall utilization increasing by 110.6 exams per 1,000 compared to 5.6 exams from nonradiologists. Radiologists performed 90% of abdominal imaging in 2005.

“Radiologists strongly predominate in abdominal imaging, as they do in noncardiac thoracic studies,” the authors concluded. “This provides further support to the idea that imaging utilization can remain under control when there are fewer opportunities for self-referral.”

ONC Distributes Federal Health IT Plan

The Office of the National Coordinator for Health Information Technology (ONC), a section of the US Department of Health and Human Services (HHS), recently released a plan for advancing health information technology. The 115-page report was written as a guide for the coordination of the federal government’s health IT efforts, which strive to accomplish nationwide implementation of an interoperable health IT infrastructure throughout the public and private sectors.

Called “The ONC-Coordinated Federal Health Information Technology Strategic Plan: 2008-2012,” the document targets two primary areas—patient-focused health care and population health.

“Significant work has been completed to date to advance the nationwide health IT agenda,” said Robert Kolodner, MD, National Coordinator for Health Information Technology. “The plan provides an extensive documentation of the work completed by ONC and other federal partners over the past 5 years. It also establishes the next generation of health IT milestones to harness the power of information technology to help transform health and care in this country.”

According to the office, the goal for patient-focused health care encompasses a transformation to higher quality, more cost-efficient care, and meeting the needs of patients through electronic health information access and use. The report states that information generated and exchanged through an interoperable infrastructure would allow health care providers to better coordinate care through their access to comprehensive and longitudinal medical records, in addition to individuals’ access to their own records. The infrastructure would also help to reduce medical errors, support the prevention of illness, and minimize duplicate tests.

“Additionally, individuals will benefit from improved system-wide efficiencies through decreased paperwork, consistent and controlled access to health information, and the ability to securely access and transfer their information for purposes that may extend beyond health care,” the document continues.

The second goal of population health promotes the authorized, appropriate, and timely access to and use of electronic health information to benefit public health, biomedical research, quality improvement, and emergency preparedness.

“Such use would promote early and effective management of infectious disease outbreaks, improved tracking of chronic disease management, the ability to gather data for research purposes, and the evaluation of health care based on value, by way of comparable price and quality information,” according to the plan.

The plan goes on to list objectives, strategies, and milestones for each goal, portraying the totality of the requirements of the federal government to address privacy and security concerns, achieve an interoperable health IT architecture, accelerate IT adoption, and foster collaborative governance.

The complete plan—developed by ONC in collaboration with 12 agencies and staff divisions within HHS; the Departments of Commerce, Defense, and Veterans Affairs; and the Federal Communications Commission—can be found at www.hhs.gov/healthit.

The National Committee on Vital and Health Statistics and the American Health Information Community also contributed to the strategies and milestones cited in the plan.