title: Trends in outpatient MRI seem to reflect recent reimbursement cuts.
abstract: OBJECTIVE
  To determine whether recent reimbursement cuts have resulted in a shift of outpatient MRI from private offices to hospital outpatient departments (HOPDs); and to study office MRI utilization trends among radiologists and other specialists.
  
  
  METHODS
  The Medicare Part B Physician/Supplier Procedure Summary Master Files were used. MRI codes were aggregated, and total MRI volumes from 2002 to 2012 were studied. Medicare place-of-service codes were used to identify studies performed in private offices and HOPDs and create trend lines. Specialty codes were used to categorize private office MRI users as radiologists, orthopedic surgeons, other physicians, and independent diagnostic testing facilities.
  
  
  RESULTS
  Medicare office and HOPD utilization of MRI (all specialties) rose rapidly from 2002 to 2006, reaching 2,727,807 in offices and 2,355,641 in HOPDs. Thereafter, office volume steadily declined, whereas HOPD volume steadily increased. By 2012, more studies were done in HOPDs than in offices. Over the entire period from 2002 and 2012, office MRI volume among radiologists increased 27%, compared with 216% among orthopedic surgeons and 124% among other physicians.
  
  
  CONCLUSIONS
  Although the majority of Medicare outpatient MRI studies had previously been performed in private offices, recent years brought a shift, with more now being performed in HOPDs. This change will increase costs to payers, because reimbursements to HOPDs are generally higher than those to offices. Although radiologists perform the majority of MRI exams that are conducted in private offices, the rate of growth for such exams from 2002 to 2012 was considerably higher among orthopedic surgeons and other physicians than among radiologists.
authors.affiliation: Center for Research on Utilization of Imaging Services (CRUISE), Department of Radiology, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania; HealthHelp, Inc, Houston, Texas. Electronic address: david.levin@jefferson.edu.
authors.forename: David C
authors.initials: DC
authors.lastname: Levin
authors.affiliation: Center for Research on Utilization of Imaging Services (CRUISE), Department of Radiology, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania.
authors.forename: Vijay M
authors.initials: VM
authors.lastname: Rao
authors.affiliation: Center for Research on Utilization of Imaging Services (CRUISE), Department of Radiology, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania.
authors.forename: Laurence
authors.initials: L
authors.lastname: Parker
mesh_terms: D000553:Ambulatory Care / Q000191:economics* / Q000706:statistics & numerical data; D003363:Cost Control / Q000191:economics / Q000639:trends; D007349:Insurance, Health, Reimbursement / Q000191:economics* / Q000706:statistics & numerical data / Q000639:trends; D008279:Magnetic Resonance Imaging / Q000191:economics* / Q000706:statistics & numerical data*; D006278:Medicare / Q000191:economics* / Q000639:trends; D010044:Outpatient Clinics, Hospital / Q000191:economics* / Q000706:statistics & numerical data; D010818:Practice Patterns, Physicians' / Q000191:economics / Q000706:statistics & numerical data / Q000639:trends; D011331:Private Practice / Q000191:economics / Q000706:statistics & numerical data / Q000639:trends; D011871:Radiology / Q000191:economics / Q000706:statistics & numerical data / Q000639:trends; D014481:United States; D014600:Utilization Review
keywords: MRI; Medical economics; advanced imaging; imaging utilization; radiology and radiologists; socioeconomic issues