title: The Shift in Outpatient Advanced Imaging From Private Offices to Hospital Facilities.
abstract: OBJECTIVE
  To study recent outpatient imaging trends in private offices and hospital outpatient departments (HOPDs), to determine if shifting between the two has occurred. Concern is currently focused on whether reduced reimbursements and other factors might lead to a shift to higher-cost HOPDs.
  
  
  METHODS
  The nationwide Medicare Physician/Supplier Procedure Summary Master Files for 2001 to 2013 were studied. All Current Procedural Terminology codes for MRI, echocardiography, nuclear medicine, ultrasound, and CT were selected, and procedure utilization rates per 1,000 Medicare beneficiaries were determined for each year. Medicare location codes identified the settings where the scans were performed.
  
  
  RESULTS
  Total utilization rates, per 1,000 beneficiaries, of all these examination types in private offices, grew from 478 in 2001, to 874 in 2008 (+83%), and then declined to 503 in 2011 (-42%), primarily as a result of code bundling. No further bundling occurred in 2012 or 2013, but the decline continued in those years, to 462. In HOPDs, the total rate rose from 416 in 2001, to 523 in 2008 (+26%), followed by similar bundling-related declines, to 418 (-20%) in 2011. But in 2012 and 2013, in contrast to private office trends, the HOPD rate increased to 447. The ratio of private office to HOPD advanced imaging was 1.67 in 2008, declining to 1.03 in 2013. In addition, individual modality shifts away from offices and into HOPDs were quite apparent.
  
  
  CONCLUSIONS
  In recent years, a shift has occurred in utilization of all advanced imaging modalities, from private offices to HOPDs. This change could portend a loss of access for patients and an increase in costs.
authors.affiliation: Department of Radiology, Thomas Jefferson University Hospitals, Philadelphia, Pennsylvania. Electronic address: bhavik.patel.2@jefferson.edu.
authors.forename: Bhavik P
authors.initials: BP
authors.lastname: Patel
authors.affiliation: Department of Radiology, Thomas Jefferson University Hospitals, Philadelphia, Pennsylvania.
authors.forename: David C
authors.initials: DC
authors.lastname: Levin
authors.affiliation: Department of Radiology, Thomas Jefferson University Hospitals, Philadelphia, Pennsylvania.
authors.forename: Laurence
authors.initials: L
authors.lastname: Parker
authors.affiliation: Department of Radiology, Thomas Jefferson University Hospitals, Philadelphia, Pennsylvania.
authors.forename: Vijay M
authors.initials: VM
authors.lastname: Rao
mesh_terms: D000553:Ambulatory Care / Q000706:statistics & numerical data* / Q000639:trends*; D003952:Diagnostic Imaging / Q000706:statistics & numerical data* / Q000639:trends; D010044:Outpatient Clinics, Hospital / Q000706:statistics & numerical data* / Q000639:trends*; D011331:Private Practice / Q000706:statistics & numerical data* / Q000639:trends; D011872:Radiology Department, Hospital / Q000706:statistics & numerical data; D014481:United States; D014600:Utilization Review
keywords: Medical economics; advanced imaging; imaging utilization; radiology and radiologists; socioeconomic issues