title: State Variation in Medical Imaging: Despite Great Variation, the Medicare Spending Decline Continues.
abstract: OBJECTIVE
  The purpose of this study was to assess state-level trends in per beneficiary Medicare spending on medical imaging.
  
  
  METHODS
  Medicare part B 5% research identifiable files from 2004 through 2012 were used to compute national and state-by-state annual average per beneficiary spending on imaging. State-to-state geographic variation and temporal trends were analyzed.
  
  
  RESULTS
  National average per beneficiary Medicare part B spending on imaging increased 7.8% annually between 2004 ($350.54) and its peak in 2006 ($405.41) then decreased 4.4% annually between 2006 and 2012 ($298.63). In 2012, annual per beneficiary spending was highest in Florida ($367.25) and New York ($355.67) and lowest in Ohio ($67.08) and Vermont ($72.78). Maximum state-to-state geographic variation increased over time, with the ratio of highest-spending state to lowest-spending state increasing from 4.0 in 2004 to 5.5 in 2012. Spending in nearly all states decreased since peaks in 2005 (six states) or 2006 (43 states). The average annual decrease among states was 5.1% ± 1.8% (range, 1.2-12.2%) The largest decrease was in Ohio. In only two states did per beneficiary spending increase (Maryland, 12.5% average annual increase since 2005; Oregon, 4.8% average annual increase since 2008).
  
  
  CONCLUSIONS
  Medicare part B average per beneficiary spending on medical imaging declined in nearly every state since 2005 and 2006 peaks, abruptly reversing previously reported trends. Spending continued to increase, however, in Maryland and Oregon. Identification of state-level variation may facilitate future investigation of the potential effect of specific and regional changes in spending on patient access and outcomes.
authors.affiliation: 1 Department of Radiology, Center for Biomedical Imaging, NYU School of Medicine, NYU Langone Medical Center, 660 First Ave, 3rd Fl, New York, NY 10016.
authors.forename: Andrew B
authors.initials: AB
authors.lastname: Rosenkrantz
authors.affiliation: 2 Harvey L. Neiman Health Policy Institute, Reston, VA.|3 Department of Health Administration and Policy, George Mason University, Fairfax, VA.
authors.forename: Danny R
authors.initials: DR
authors.lastname: Hughes
authors.affiliation: 2 Harvey L. Neiman Health Policy Institute, Reston, VA.|4 Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, GA.
authors.forename: Richard
authors.initials: R
authors.lastname: Duszak
mesh_terms: D003952:Diagnostic Imaging / Q000191:economics*; D005245:Fee Schedules; D006291:Health Policy; D006801:Humans; D006278:Medicare / Q000191:economics*; D014481:United States
keywords: Medicare; medical imaging; regional variation; spending; states