JACR: Did self-referral spark 700% leap in MSK ultrasound?
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Previous researchers had suggested that MSK ultrasound, which is underutilized in the U.S., could help curb imaging costs when used as a substitute for MRI in specific indications, such as rotator cuff tears. At the same time, payors have expressed concerns about MSK ultrasound overutilization, partially stemming from the widespread proliferation of ultrasound systems.
Richard E. Sharpe, MD, MBA, from the Center for Research on Utilization of Imaging Services at Thomas Jefferson University Hospital in Philadelphia, and colleagues sought to determine which physicians use diagnostic MSK ultrasound, and the settings, relative utilization frequencies and geographic variations.
The researchers mined the Centers for Medicare & Medicaid Services Part B Physician Supplier Procedure Summary Master Files for 2000 to 2009 to analyze claims for diagnostic MSK ultrasound.
“Musculoskeletal ultrasound volume increased from 56,254 procedures in 2000 to 233,964 in 2009,” wrote Sharpe and colleagues. During the study period, radiologists’ use of MSK ultrasound increased 123 percent. However, their share of volume dropped from 73 percent in 2000 to 39 percent in 2009.
Meanwhile, podiatrists’ use increased 1,847 percent from 2000 to 2009, from 3,920 procedures to 76,332 exams. Their increased use accounted for 52 percent of the total private office growth during the study period, according to Sharpe et al.
Sharpe and colleagues reflected on the findings in light of recent reports from the U.S. Government Accountability Office which found substantial geographic variation of in-office imaging, suggesting “not all utilization was necessary or appropriate.”
Previous studies had estimated that substituting MSK ultrasound for MRI, when appropriate, could generate nearly $7 billion in savings from 2006 to 2020. However, Sharpe et al found no evidence of MSK ultrasound being used as a surrogate for MSK MRI, as use of both modalities has increased.
Instead, the researchers reported potential self-referral, noting that nonradiologists account for the bulk of in-office MSK ultrasound and fueled 72 percent of the increased volume from 2000 to 2009.
“Private office MSK ultrasound examinations may be relatively free of scrutiny, peer review, validation or regulation. It is possible, particularly in a slow economy, that MSK ultrasound examinations are being performed more frequently to subsidize ultrasound equipment that has already been procured. When imaging equipment has already been purchased and is idle in practice settings, it may become used for situations and indications for which it was not previously perceived as necessary,” concluded Sharpe and colleagues.