title: Same-Day Sinus and Brain CT Imaging in the Medicare Population: Are Practice Patterns Changing in Association with Medicare Policy Initiatives?
abstract: Monitoring the frequency of same-day sinus and brain CT (Outpatient Measure 14, "OP-14") is part of a recent large Centers for Medicare and Medicaid Services hospital outpatient quality initiative to improve imaging efficiency. This study investigates patient-level claims data in the Medicare population focusing on where same-day sinus and brain CT imaging is performed and how the frequency of same-day studies changed with time before and during OP-14 measure program implementation.
  
  
  
  Research Identifiable Files were used to identify all sinus and brain CT examinations from 2004 through 2012 for a 5% random patient sample of Medicare fee-for-service beneficiaries. Overall and site of service use rates were calculated for same- and non-same-day examinations. Changes were mapped to policy initiative timetables.
  
  
  
  The number of same-day sinus and brain CT studies from 2004 to 2012 increased 67% from 1.85 (95% CI, 1.78-1.91) per 1000 Medicare beneficiaries in 2004 to 3.08 (95% CI, 3.00-3.15) in 2012. The biggest driver of increased same-day studies was the emergency department setting, from 0.56 (95% CI, 0.53-0.60) per 1000 to 1.78 (95% CI, 1.72-1.84; +215.7%). Overall use of brain CT from 146.0 (95% CI, 145.1-146.9) per 1000 to 176.3 (95% CI, 175.4-177.2; +21%) and sinus CT from 12.6 (95% CI, 12.4-12.8) per 1000 to 15.4 (95% CI, 15.2-15.6; +22%) increased until 2009 and remained stable through 2012.
  
  
  
  Previously increasing same-day sinus and brain CT in Medicare beneficiaries plateaued in 2009, coinciding with the implementation of targeted measures by the Centers for Medicare and Medicaid Services. Same-day imaging continues to increase in the emergency department setting.
authors.affiliation: From the Department of Radiology (H.K., M.W.), Neuroradiology Section, Stanford University, Stanford, California.
authors.forename: H
authors.identifier: 0000-0001-9257-1545
authors.initials: H
authors.lastname: Kroll
authors.affiliation: Harvey L. Neiman Health Policy Institute (R.D., J.H., D.H.), Reston, Virginia Department of Radiology and Imaging Sciences (R.D.), Emory University School of Medicine, Atlanta, Georgia.
authors.forename: R
authors.identifier: 0000-0003-0425-3008
authors.initials: R
authors.lastname: Duszak
authors.affiliation: Harvey L. Neiman Health Policy Institute (R.D., J.H., D.H.), Reston, Virginia.
authors.forename: J
authors.identifier: 0000-0003-2924-8301
authors.initials: J
authors.lastname: Hemingway
authors.affiliation: Harvey L. Neiman Health Policy Institute (R.D., J.H., D.H.), Reston, Virginia Department of Health Administration and Policy (D.H.), George Mason University, Fairfax, Virginia.
authors.forename: D
authors.identifier: 0000-0001-6227-9500
authors.initials: D
authors.lastname: Hughes
authors.affiliation: From the Department of Radiology (H.K., M.W.), Neuroradiology Section, Stanford University, Stanford, California Max.Wintermark@gmail.com.
authors.forename: M
authors.identifier: 0000-0002-6726-3951
authors.initials: M
authors.lastname: Wintermark
mesh_terms: D001921:Brain / Q000000981:diagnostic imaging*; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data; D006801:Humans; D006278:Medicare; D059906:Neuroimaging / Q000706:statistics & numerical data*; D010256:Paranasal Sinuses / Q000000981:diagnostic imaging*; D014057:Tomography, X-Ray Computed / Q000706:statistics & numerical data*; D014481:United States
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