title: Advanced diagnostic imaging in privately insured patients: recent trends in utilization and payments.
abstract: Recent studies have reported that the rate of growth in utilization of noninvasive diagnostic imaging has slowed, with a concomitant reduction in total payments to providers in the Medicare Part B fee-for-service population. Utilization and payment growth trends in commercially insured populations, however, are not as well understood. We used the Truven Health Analytics MarketScan® Commercial Claims and Encounters database containing more than 29 million individuals to investigate commercially insured population trends in utilization of and payments for CT, MRI, PET, and ultrasound procedures in the years 2007-2011. We found that imaging use--after a brief downturn in 2010--rose again in 2011, coupled with substantial increases in adjusted payments for all four imaging modalities, raising concerns about future efforts to stem growth in imaging use and associated spending.
authors.affiliation: Boston University School of Public Health, Boston, Massachusetts. Electronic address: mhorny@bu.edu.
authors.forename: Michal
authors.initials: M
authors.lastname: Horný
authors.affiliation: United States Department of Veterans Affairs, Boston, Massachusetts; Boston University School of Public Health, Boston, Massachusetts.
authors.forename: James F
authors.initials: JF
authors.lastname: Burgess
authors.affiliation: Boston University School of Management, Boston, Massachusetts.
authors.forename: Jedediah
authors.initials: J
authors.lastname: Horwitt
authors.affiliation: Boston University School of Management, Boston, Massachusetts.
authors.forename: Alan B
authors.initials: AB
authors.lastname: Cohen
mesh_terms: D003952:Diagnostic Imaging / Q000191:economics* / Q000706:statistics & numerical data* / Q000639:trends; D005102:Health Expenditures / Q000706:statistics & numerical data* / Q000639:trends; D007345:Insurance Claim Review; D007348:Insurance, Health / Q000191:economics* / Q000706:statistics & numerical data* / Q000639:trends; D007349:Insurance, Health, Reimbursement / Q000191:economics* / Q000706:statistics & numerical data / Q000639:trends; D017149:Private Sector / Q000191:economics* / Q000706:statistics & numerical data; D014600:Utilization Review
keywords: Diagnostic imaging; commercial insurance; payments; utilization