Responses to a payment policy denying professional charges for diagnostic imaging by nonradiologist physicians
B. J. Hillman, G. T. Olson, R. W. Colbert and L. B. Bernhardt
Department of Radiology, University of Virginia, Charlottesville, USA.
OBJECTIVE--To assess the impact of a payment policy denying reimbursement
for the imaging-related professional services of nonradiologist physicians
by comparing the use of and expenditures for diagnostic imaging
examinations before and after implementation of the policy.
DESIGN--Retrospective economic evaluation of claims and expenditures for
diagnostic imaging examinations filed by physicians practicing in the 20 US
counties having the greatest number of United Mine Workers of America
Health and Retirement Funds (hereafter referred to as Funds) beneficiaries.
SETTING--Insurance claims database of Funds beneficiaries, most of whom are
elderly and live in rural communities and small towns. INTERVENTION--The
January 1, 1993, implementation of a reimbursement policy denying payment
of professional claims for diagnostic imaging of nonradiologist physicians.
MAIN OUTCOME MEASURES--Numbers and types of eligible claims and Funds
payments for diagnostic imaging examinations during the year before and
after the intervention, normalized for changes in the number of
beneficiaries. RESULTS--Despite the rejection of $811,466 in claims
disallowed by the policy, the Funds paid 12% more for diagnostic imaging
performed in the 20 counties we studied during 1993 than during 1992. The
Funds reimbursed 41% more claims per beneficiary for diagnostic imaging in
1993 than in 1992 (t = -8.03, P < .0001). The absolute number of
professional claims per beneficiary increased more than did technical or
global claims. CONCLUSIONS--Despite a payment policy designed, in part, to
reduce the Funds' imaging-related expenditures, the physicians we studied
filed more claims, leading to greater expenditures. An increased number of
self-referred technical claims and greater referral to hospital radiology
departments likely account for most of the observed increases in
utilization and costs.
