Abdominal imaging ordering patterns by referring provider specialty
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Prior work has demonstrated marked growth in the volume of abdominal imaging performed by radiologists. However, decisions to pursue imaging are largely driven by referring providers. In this study, we take the novel approach of investigating abdominal imaging utilization patterns by referring provider specialty.
Data on imaging services were obtained from the 2014 DocGraph Medicare Referring Provider Utilization for Procedures (MrPUP) public use file. MrPUP contains aggregated transaction data for combinations of unique referring provider and service code. Imaging services were classified by modality and body region using the Neiman Institute Types of Service (NITOS). Each referring provider’s specialty was determined using Medicare Physician Compare. Abdominal imaging ordering patterns were summarized by referring specialty.
The final dataset included 5,824,754 abdominal imaging transactions. The most common ordering specialties of abdominal imaging were as follows: (1) internal medicine; (2) urology; (3) emergency medicine; (4) family practice; and (5) gastroenterology. The most common ordering specialties by abdominal imaging modality were emergency medicine for CT; gastroenterology for MRI and nuclear medicine; and internal medicine for ultrasound and radiography. While numerous specialties commonly ordered abdominal radiography and CT, urologists also commonly ordered retroperitoneal ultrasound and retrograde urography, and gastroenterologists also commonly ordered abdominal ultrasound, abdominal MRI, and esophagrams. Internal medicine, family practice, and emergency medicine providers ordered a much broader mix of imaging, including many non-abdominal imaging examinations.
Referring specialty abdominal imaging ordering patterns are varied but distinct. Awareness of these patterns may facilitate focused educational and policy initiatives to improve abdominal imaging appropriateness and utilization.
KeywordsAbdominal imaging Referring provider Physician specialties Medicare Utilization Health policy
Compliance with ethical standards
Authors Andrew B. Rosenkrantz and Richard Duszak Jr. are supported by research grants from the Harvey L. Neiman Health Policy Institute.
Conflicts of interest
The authors declare that they have no conflict of interest.
This article does not contain any studies with human participants performed by any of the authors.
Statement of informed consent was not applicable since the manuscript does not contain any patient data.
- 2.United States Congress. H.R.4302—Protecting Access to Medicare Act of 2014. https://www.congress.gov/bill/113th-congress/house-bill/4302. Accessed on: November 16, 2016.
- 3.Center for Medicare & Medicid Services. 42 CFR Parts 414 and 495. Medicare Program; Merit-Based Incentive Payment System (MIPS) and Alternative Payment Model (APM) Incentive Under the Physician Fee Schedule, and Criteria for Physician Focused Payment Models Published on: November 4, 2016. Accessed on: November 16, 2016.Google Scholar
- 4.The ABIM Foundation. Choosing Wisely. http://www.choosingwisely.org/. Accessed on: November 16, 2016.
- 8.DocGraph. MrPUP Data Documentation. https://mrpup.docgraph.com/doc.html. Accessed on: November 16, 2016.
- 9.DocGraph. MrPUP 2014 Dataset. https://mrpup.docgraph.com/. Accessed on: November 16, 2016.
- 10.Harvey L. Neiman Health Policy Institute. Neiman Imaging Types of Service (NITOS). http://www.neimanhpi.org/neiman-imaging-types-of-service-nitos/. Accessed on: November 16, 2016.
- 11.Harvey L. Neiman Health Policy Institute. Neiman Imaging Types of Service (NITOS). http://www.neimanhpi.org/wp-content/uploads/2016/08/nitos_fulllist_final.xlsx. Accessed on: December 23, 2016.
- 12.Center for Medicare & Medicaid Services. CMS Data Navigator. https://dnav.cms.gov/. Accessed on: Novermber 16, 2016.
- 13.Obele CC, Duszak R, Jr., Hawkins CM, Rosenkrantz AB (2016) What patients think about their interventional radiologists: assessment using a leading physician ratings website. J Am Coll Radiol. doi: 10.1016/j.jacr.2016.10.013.
- 15.Center for Medicare & Medicaid Services. Internet-based PECOS. https://www.cms.gov/medicare/provider-enrollment-and-certification/medicareprovidersupenroll/internetbasedpecos.html. Modified on: November 4, 2016. Accessed on: November 16, 2016.