title: Recent reimbursement changes and their effect on hospital and private office use of myocardial perfusion imaging.
abstract: OBJECTIVE
  The aims of this study were to examine recent trends in the utilization of radionuclide myocardial perfusion imaging (MPI) and to reflect on their causes and their implications for radiologists.
  
  
  METHODS
  Nationwide Medicare Part B databases for 2000 through 2010 were used. Codes for primary MPI studies (including PET) were selected. Medicare specialty codes were used to identify MPI examinations done by radiologists, cardiologists, and other physicians. Place-of-service codes were used to identify examinations performed in offices versus hospital settings. Utilization rates per 1,000 fee-for-service beneficiaries were calculated. Trends were assessed by place of service and specialty.
  
  
  RESULTS
  The overall MPI utilization rate rose from 2000 through 2004, followed by a period of stabilization from 2005 to 2008. A peak of 88.0 per 1,000 was reached in 2006. In 2009 and 2010, a decline occurred, with the rate dropping by 13% to 76.9. In private offices, cardiologists' utilization grew rapidly from 2000 through 2006, but growth stopped thereafter. Their rate peaked in 2008 at 50.6 but dropped to 44.4 by 2010 (-12%). Radiologists' role in office MPI was minimal. In hospital settings, radiologists predominated in 2000. Their rate remained stable through 2004 but thereafter began to decline steadily, dropping by 35% by 2010. Cardiologists' hospital-based utilization rate rose gradually, then flattened, but began to rise in 2009 and 2010. By 2010, cardiologists performed more hospital MPI examinations than radiologists.
  
  
  CONCLUSIONS
  Radiologists' initially predominant role in hospital-based MPI has eroded recently, while that of cardiologists has strengthened. This seems related to a shift among cardiologists away from office practice and into hospital affiliations.
authors.affiliation: Center for Research on Utilization of Imaging Services, Department of Radiology, Thomas Jefferson University Hospital , Philadelphia, Pennsylvania 19107, USA. david.levin@jeffersonhospital.org
authors.forename: David C
authors.initials: DC
authors.lastname: Levin
authors.forename: Laurence
authors.initials: L
authors.lastname: Parker
authors.forename: Charles M
authors.initials: CM
authors.lastname: Intenzo
authors.forename: Vijay M
authors.initials: VM
authors.lastname: Rao
mesh_terms: D002309:Cardiology / Q000191:economics*; D059019:Clinical Coding; D018588:Fee-for-Service Plans / Q000191:economics; D006801:Humans; D016345:Medicare Part B / Q000191:economics*; D055414:Myocardial Perfusion Imaging / Q000191:economics* / Q000706:statistics & numerical data*; D010818:Practice Patterns, Physicians' / Q000191:economics*; D012051:Reimbursement Mechanisms / Q000191:economics*; D014481:United States