title: Changing Abdominal Imaging Utilization Patterns: Perspectives From Medicare Beneficiaries Over Two Decades.
abstract: OBJECTIVE
  To assess changing utilization patterns of abdominal imaging in the Medicare fee-for-service population over the past two decades.
  
  
  METHODS
  Medicare Physician Supplier Procedure Summary master files from 1994 through 2012 were used to study changes in the frequency and utilization rates (per 1,000 Medicare beneficiaries per year) of abdominal CT, MRI, ultrasound, and radiography.
  
  
  RESULTS
  In Medicare beneficiaries, the most frequently performed abdominal imaging modality changed from radiography in 1994 (207.4 per 1,000 beneficiaries) to CT in 2012 (169.0 per 1,000). Utilization rates of abdominal MR (1037.5%), CT (197.0%), and ultrasound (38.0%) all increased from 1994-2012 (but declined briefly from 2007 to 2009). A dramatic 20-year utilization rate decline occurred for gastrointestinal fluoroscopic examinations (-91.9% barium enema, -80.0% upper gastrointestinal series) and urologic radiographic examinations (-95.3%). Radiologists were the dominant providers of all modalities, accounting for >90% of CT and MR studies, and >75% of most ultrasound examination types.
  
  
  CONCLUSIONS
  Medicare utilization of abdominal imaging has markedly changed over the past two decades, with overall dramatic increases in CT and MRI and dramatic decreases in gastrointestinal fluoroscopic and urologic radiographic imaging. Despite these changes, radiologists remain the dominant providers in all abdominal imaging modalities.
authors.affiliation: Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia. Electronic address: courtney.moreno@emoryhealthcare.org.
authors.forename: Courtney C
authors.initials: CC
authors.lastname: Moreno
authors.affiliation: Harvey L. Neiman Health Policy Institute, Reston, Virginia.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Hemingway
authors.affiliation: Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia.
authors.forename: Aileen C
authors.initials: AC
authors.lastname: Johnson
authors.affiliation: Harvey L. Neiman Health Policy Institute, Reston, Virginia; Department of Health Administration and Policy, George Mason University, Fairfax, Virginia.
authors.forename: Danny R
authors.initials: DR
authors.lastname: Hughes
authors.affiliation: Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia.
authors.forename: Pardeep K
authors.initials: PK
authors.lastname: Mittal
authors.affiliation: Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia; Harvey L. Neiman Health Policy Institute, Reston, Virginia.
authors.forename: Richard
authors.initials: R
authors.lastname: Duszak
mesh_terms: D000005:Abdomen / Q000000981:diagnostic imaging*; D003952:Diagnostic Imaging / Q000706:statistics & numerical data* / Q000639:trends*; D018588:Fee-for-Service Plans / Q000706:statistics & numerical data*; D005471:Fluoroscopy / Q000706:statistics & numerical data / Q000639:trends; D006801:Humans; D007342:Insurance Benefits / Q000706:statistics & numerical data*; D008279:Magnetic Resonance Imaging / Q000706:statistics & numerical data / Q000639:trends; D006278:Medicare / Q000706:statistics & numerical data*; D011860:Radiography, Abdominal / Q000706:statistics & numerical data / Q000639:trends; D014057:Tomography, X-Ray Computed / Q000706:statistics & numerical data / Q000639:trends; D014463:Ultrasonography / Q000706:statistics & numerical data / Q000639:trends; D014481:United States / Q000453:epidemiology; D014567:Urography / Q000706:statistics & numerical data / Q000639:trends; D014600:Utilization Review
keywords: Utilization; abdominal CT; abdominal MR; abdominal radiography; abdominal ultrasound