Using Medical Claims for Policy Effectiveness Surveillance: Reimbursement and Utilization of Abdomen/Pelvis Computed Tomography Scans.
OBJECTIVE
To quantify changes in private insurance payments for and utilization of abdominal/pelvic computed tomography scans (CTs) after 2011 changes in CPT coding and Medicare reimbursement rates, which were designed to reduce costs stemming from misvalued procedures.


METHODS
TruvenHealth Analytics MarketScan Commercial Claims and Encounters database.


METHODS
We used difference-in-differences models to compare combined CTs of the abdomen/pelvis to CTs of the abdomen or pelvis only. Our main outcomes were inflation-adjusted log payments per procedure, daily utilization rates, and total annual payments.


METHODS
Claims data were extracted for all abdominal/pelvic CTs performed in 2009-2011 within noncapitated, employer-sponsored private plans.


RESULTS
Adjusted payments per combined CTs of the abdomen/pelvis dropped by 23.8 percent (p < .0001), and their adjusted daily utilization rate accelerated by 0.36 percent (p = .034) per month after January 2011. Utilization rate of abdominal-only or pelvic-only CTs dropped by 5.0 percent (p < .0001). Total annual payments for combined CTs of the abdomen/pelvis decreased in 2011 despite the increased utilization.


CONCLUSIONS
Private insurance payments for combined CTs of the abdomen/pelvis declined and utilization accelerated significantly after 2011 policy changes. While growth in total annual payments was contained in 2011, it may not be sustained if 2011 utilization trends persist.
Department of Health Policy and Management, Boston University School of Public Health, Boston, MA.
Michal
M
Horný
Department of Health Policy and Management, Boston University School of Public Health, Boston, MA.
Jake R
JR
Morgan
Department of Health Policy and Management, Boston University School of Public Health, Boston, MA.
Vanessa L
http://orcid.org/0000-0002-4542-5227
VL
Merker
D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D039702:Current Procedural Terminology; D005260:Female; D006264:Health Benefit Plans, Employee; D006302:Health Services Research; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007345:Insurance Claim Review; D007349:Insurance, Health, Reimbursement / Q000191:economics / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D010388:Pelvis / Q000000981:diagnostic imaging*; D011860:Radiography, Abdominal / Q000191:economics / Q000706:statistics & numerical data*; D014054:Tomography / Q000191:economics / Q000379:methods*; D014481:United States; D055815:Young Adult
CPT codes; Health insurance reimbursement; computed tomography; fee-for-service plans; health policy; utilization