title: Professional component payment reductions for diagnostic imaging examinations when more than one service is rendered by the same provider in the same session: an analysis of relevant payment policy.
abstract: OBJECTIVE
  The aim of this study was to assess potential physician work efficiencies when more than one diagnostic imaging study is interpreted by the same provider during the same session.
  
  
  METHODS
  Medicare Physician Fee Schedule data from the American Medical Association Resource-Based Relative Value Scale Data Manager for 2011 were analyzed to quantify relative contributions of preservice, intraservice, and postservice physician work to the total work of rendering diagnostic imaging services. An expert panel review identified potential duplications in preservice and postservice work when multiple examinations are performed on the same patient during the same session. Maximum potential percentage work duplication for various diagnostic imaging modalities was calculated and compared to US Government Accountability Office estimates.
  
  
  RESULTS
  The relative contributions of preservice and postservice work to total work varied by modality, ranging from 20% [computed tomography (CT)] to 33% (ultrasound). The maximum percentage of potentially duplicated preservice and postservice activity ranged from 19% (nuclear medicine) to 24% (ultrasound). Maximum mean potentially duplicated work relative value units ranged from 0.0212 for radiography to 0.0953 for magnetic resonance imaging (MRI). Maximum percentage work reduction ranged from 4.32% for CT to 8.15% for ultrasound. This corresponds to maximum professional Physician Fee Schedule reductions of only 2.96% (CT) to 5.45% (ultrasound), approximating an order of magnitude less than the Government Accountability Office's recommendations.
  
  
  CONCLUSIONS
  Although potential efficiencies in physician work occur when multiple services are provided to the same patient during the same session, these are highly variable and considerably less than previously estimated.
authors: Trinity Medical Center, Birmingham, Alabama 35213, USA. bibb@mac.com
authors: Bibb
authors: B
authors: Allen
authors: William D
authors: WD
authors: Donovan
authors: Geraldine
authors: G
authors: McGinty
authors: Robert M
authors: RM
authors: Barr
authors: Ezequiel
authors: E
authors: Silva
authors: Richard
authors: R
authors: Duszak
authors: Angela J
authors: AJ
authors: Kim
authors: Pam
authors: P
authors: Kassing
mesh_terms: D039702:Current Procedural Terminology; D003952:Diagnostic Imaging / Q000191:economics*; D017598:Efficiency, Organizational; D005245:Fee Schedules / Q000592:standards*; D006302:Health Services Research; D006801:Humans; D006278:Medicare / Q000191:economics*; D010818:Practice Patterns, Physicians' / Q000191:economics*; D015895:Relative Value Scales; D014481:United States; D016526:Workload