Original articleDramatically Increased Musculoskeletal Ultrasound Utilization From 2000 to 2009, Especially by Podiatrists in Private Offices
Introduction
Policymakers, health care payers, health care providers, and patients are increasingly aware of the cost of providing health care in the United States. Medical imaging is one of the main drivers of increasing health care costs [1]. For musculoskeletal (MSK) imaging, Parker et al [2] demonstrated that MSK ultrasound is relatively underutilized in the United States and that substituting ultrasound for MRI in specific clinical scenarios could substantially reduce imaging costs. Paradoxically, insurers have recently raised concerns of MSK ultrasound overutilization [3]. In particular, the wide availability and relatively low cost of ultrasound technology have led to widespread proliferation of ultrasound units and potential for overutilization.
The purpose of this study was to examine MSK ultrasound used for the diagnosis of tendon, muscle, ligament, nerve, and joint abnormalities; we do not address studies performed for ultrasound-guided intervention. We investigated which types of health care providers in what settings utilize diagnostic MSK ultrasound, their relative utilization frequencies, and geographic variations.
Section snippets
Methods
The source data sets were the CMS Part B Physician/Supplier Procedure Summary Master Files (PSPSMFs) for 2000 through 2009. This data set summarizes the complete billing record for all procedures paid under Medicare Part B. For every Current Procedural Terminology®, fourth ed (CPT®-4), code in each year, the PSPSMFs provide the volume of services performed nationwide. There were 32,823,781 fee-for-service beneficiaries enrolled in Medicare Part B in 2000 and 34,937,790 in 2009, with a peak
Results
Musculoskeletal ultrasound volume increased from 56,254 procedures in 2000 to 233,964 in 2009 (+316%). The total utilization rate of MSK ultrasound was 171 per 100,000 in 2000 and 669 per 100,000 in 2009 (+291%).
Figure 1 shows that MSK ultrasound procedure volume varied by provider type. The largest number of MSK ultrasound procedures in every year from 2000 to 2009 was performed by radiologists who performed 40,877 procedures in 2000 and 91,022 in 2009 (+123%). Radiologists' volume accounted
Discussion
The US Government Accountability Office (GAO) [1] stated that from 2000 to 2006, spending for medical imaging more than doubled, to $14 billion. The GAO has also reported that from 2000 through 2006, Medicare spending for physician imaging services doubled from about $7 billion to about $14 billion, an average annual increase of 13%, compared with an 8% increase in spending for all Medicare physician-billed services over the same time period [4]. The GAO further concluded that there was
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