title: Advanced Imaging Utilization Trends in Privately Insured Patients From 2007 to 2013.
abstract: OBJECTIVE
  The aim of the study was to investigate whether the increase in utilization of advanced diagnostic imaging for privately insured patients in 2011 was the beginning of a new trend in imaging utilization growth, or an isolated deviation from the declining trend that began in 2008.
  
  
  METHODS
  We extracted outpatient and inpatient CT, diagnostic ultrasound, MRI, and PET procedures from databases, for the years 2007 to 2013. This study extended previous work, covering 2012 to 2013, using the same methodology. For every year of the study period, we calculated the following: number of procedures per person-year covered by private health insurance; proportion of office and emergency visits that resulted in an imaging session; average payments per procedure; and total payments per person-year covered by private health insurance.
  
  
  RESULTS
  Outpatient utilization of CT and PET decreased in both 2012 and 2013; outpatient utilization of MRI mildly increased in 2012, but then decreased in 2013. Outpatient utilization of diagnostic ultrasound showed a very different pattern, increasing throughout the study period. Inpatient utilization of all imaging modalities except PET decreased in both 2012 and 2013. Adjusted payments for all imaging modalities increased in 2012, and then dropped substantially in 2013, except the adjusted payments for diagnostic ultrasound that increased in 2013 again.
  
  
  CONCLUSIONS
  The trend of increasing utilization of advanced diagnostic imaging seems to be over for some, but not all, imaging modalities. A combination of policy (eg, breast density notification laws), technologic advancement, and wider access seems to be responsible for at least part of an increasing utilization of diagnostic ultrasound.
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: Boston University School of Public Health, Boston, Massachusetts; US Department of Veterans Affairs, Center for Healthcare Organization and Implementation Research, Boston, Massachusetts.
authors.forename: James F
authors.initials: JF
authors.lastname: Burgess
authors.affiliation: Boston University Questrom School of Business, 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; D007349:Insurance, Health, Reimbursement / Q000191:economics* / Q000706:statistics & numerical data* / Q000639:trends; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data; D017149:Private Sector / Q000191:economics* / Q000706:statistics & numerical data* / Q000639:trends; D014481:United States; D014600:Utilization Review
keywords: Diagnostic imaging utilization; payments; private insurance