title: Use of Point-of-Care Ultrasound in the Emergency Department: Insights From the 2012 Medicare National Payment Data Set.
abstract: OBJECTIVE
  Point-of-care ultrasound is a valuable tool with potential to expedite diagnoses and improve patient outcomes in the emergency department. However, little is known about national patterns of adoption. This study examined nationwide point-of-care ultrasound reimbursement among emergency medicine (EM) practitioners and examined regional and practitioner level variations.
  
  
  METHODS
  Data from the 2012 Center for Medicare and Medicaid Services Fee-for-Service Provider Utilization and Payment Data include all practitioners who received more than 10 Medicare Part B fee-for-service reimbursements for any Healthcare Common Procedure Coding System code in 2012. Odds ratios (ORs) and descriptive statistics were calculated to assess relationships between ultrasound reimbursement and practice location, nearby presence of an EM residency, and time elapsed since practitioner graduation.
  
  
  RESULTS
  Of 52,928 unique EM practitioners, 391 (0.7%) received limited ultrasound reimbursements for a total of 16,389 scans in 2012. Urban counties had an OR of 5.4 (95% confidence interval, 3.8-7.8) for receiving point-of-care ultrasound reimbursements compared to rural counties. Counties with an EM residency had an OR of 84.7 (95% confidence interval, 42.6-178.8) for reimbursement compared to counties without. The OR for receiving reimbursement was independent of medical school graduation year (P = .83); however, recent graduates performed more scans (P = .02).
  
  
  CONCLUSIONS
  A small minority of EM practitioners received reimbursements for point-of-care ultrasound from Medicare beneficiaries. These practitioners were more likely to reside in urban and academic settings. Future efforts should assess the degree to which our findings reflect either low point-of-care ultrasound use or low rates of billing for ultrasound examinations that are performed.
authors.affiliation: Division of Emergency Medicine, University of Washington School of Medicine, Seattle, Washington USA mkhall@uw.edu.|Department of Emergency Medicine, Yale University School of Medicine, New Haven, Connecticut USA mkhall@uw.edu.
authors.forename: M Kennedy
authors.initials: MK
authors.lastname: Hall
authors.affiliation: Cancer Outcomes, Public Policy, and Effectiveness Research Center, Yale Cancer Center, and Yale University School of Medicine, Section of General Internal Medicine, Department of Internal Medicine, Yale University, New Haven, Connecticut USA.
authors.forename: Jane
authors.initials: J
authors.lastname: Hall
authors.affiliation: Cancer Outcomes, Public Policy, and Effectiveness Research Center, Yale Cancer Center, and Yale University School of Medicine, Section of General Internal Medicine, Department of Internal Medicine, Yale University, New Haven, Connecticut USA.
authors.forename: Cary P
authors.initials: CP
authors.lastname: Gross
authors.affiliation: Department of Emergency Medicine, Yale University School of Medicine, New Haven, Connecticut USA.
authors.forename: Nir J
authors.initials: NJ
authors.lastname: Harish
authors.affiliation: Department of Emergency Medicine, Yale University School of Medicine, New Haven, Connecticut USA.
authors.forename: Rachel
authors.initials: R
authors.lastname: Liu
authors.affiliation: Cancer Outcomes, Public Policy, and Effectiveness Research Center, Yale Cancer Center, and Yale University School of Medicine, Section of General Internal Medicine, Department of Internal Medicine, Yale University, New Haven, Connecticut USA.
authors.forename: Sean
authors.initials: S
authors.lastname: Maroongroge
authors.affiliation: Department of Emergency Medicine, Yale University School of Medicine, New Haven, Connecticut USA.
authors.forename: Christopher L
authors.initials: CL
authors.lastname: Moore
authors.affiliation: Good Samaritan Hospital Medical Center, West Islip, New York USA.
authors.forename: Christopher C
authors.initials: CC
authors.lastname: Raio
authors.affiliation: Department of Emergency Medicine, Yale University School of Medicine, New Haven, Connecticut USA.
authors.forename: R Andrew
authors.initials: RA
authors.lastname: Taylor
mesh_terms: D003430:Cross-Sectional Studies; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D006801:Humans; D007349:Insurance, Health, Reimbursement / Q000706:statistics & numerical data; D006278:Medicare / Q000706:statistics & numerical data*; D019095:Point-of-Care Systems / Q000706:statistics & numerical data*; D012424:Rural Population / Q000706:statistics & numerical data; D014463:Ultrasonography / Q000706:statistics & numerical data*; D014481:United States; D014505:Urban Population / Q000706:statistics & numerical data
keywords: emergency medicine; health services; point-of-care ultrasound; reimbursement; technology adoption