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. 2021 Sep 30;3(5):e210156.
doi: 10.1148/ryct.2021210156. eCollection 2021 Oct.

Cardiac Imaging Trends from 2010 to 2019 in the Medicare Population

Russell A Reeves  1 , Ethan J Halpern  1 , Vijay M Rao  1
Affiliations

Cardiac Imaging Trends from 2010 to 2019 in the Medicare Population

Russell A Reeves et al. Radiol Cardiothorac Imaging. .

Abstract

Purpose: To evaluate changes in utilization of cardiac imaging-transthoracic, transesophageal, and stress echocardiography (TTE, TEE, and SE), coronary CT angiography (cCTA), cardiac MRI (cMRI), myocardial perfusion imaging (MPI), and cardiac positron emission tomography (cPET).

Materials and methods: The 2010-2019 Physician/Supplier Procedure Summary files were used to find imaging utilization per 100 000 Medicare beneficiaries. Global and professional claims were aggregated, representing total interpretive services. Specialty codes identified provider specialty. Results were stratified by physician offices, hospital outpatient departments (HOPDs), inpatient setting, and the emergency department.

Results: From 2010 to 2019, there was a partial shift from cardiologist offices to the HOPD for TTE (office: -23%; HOPD: +107%) and SE (office: -44%; HOPD: +11%). Cardiologist cCTA also shifted from the office (-57%) to the HOPD (+211%). Radiologist-performed cCTA grew in all locations but most in the HOPD (+355%), with radiologists performing more cCTA than cardiologists in all settings. cMRI rates remain low but rose in the HOPD for both cardiologists (+209%) and radiologists (+207%). Cardiologist MPI rates dropped dramatically in the office (-52%), with a smaller absolute rate increase in the HOPD (+71%). cPET nearly tripled in the cardiology office (+193%), but rates remained steady for radiologists.

Conclusion: While most cardiologist in-office imaging has shifted to the HOPD, there has been an increase in in-office cPET, likely due to a combination of technological advances, interpretation familiarity, and financial incentives. Radiologist cCTA rates continue to increase, representing a growing opportunity for radiologists to collaborate in cardiac imaging.Keywords: CT Angiography, Echocardiography, MR Imaging, PET, Radionuclide Studies, SPECT, Cardiac, Work Force Issues Supplemental material is available for this article. © RSNA, 2021.

Keywords: CT Angiography; Cardiac; Echocardiography; MR Imaging; PET; Radionuclide Studies; SPECT; Work Force Issues.

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Conflict of interest statement

Disclosures of Conflicts of Interest: R.A.R. disclosed no relevant relationships. E.J.H. disclosed no relevant relationships. V.M.R. former board member of RSNA.

Figures

Transthoracic echocardiography (TTE) rates per 100 000 Medicare beneficiaries by specialty and place of service. Card = cardiologist, ED = emergency department, HOPD = hospital outpatient department, Rad = radiologist.
Figure 1:
Transthoracic echocardiography (TTE) rates per 100 000 Medicare beneficiaries by specialty and place of service. Card = cardiologist, ED = emergency department, HOPD = hospital outpatient department, Rad = radiologist.
Stress echocardiography (SE) rates per 100 000 Medicare beneficiaries by specialty and place of service. Card = cardiologist, ED = emergency department, HOPD = hospital outpatient department, Rad = radiologist.
Figure 2:
Stress echocardiography (SE) rates per 100 000 Medicare beneficiaries by specialty and place of service. Card = cardiologist, ED = emergency department, HOPD = hospital outpatient department, Rad = radiologist.
Coronary CTA (cCTA) rates per 100 000 Medicare beneficiaries by specialty and place of service. Card = cardiologist, ED = emergency department, HOPD = hospital outpatient department, Rad = radiologist.
Figure 3:
Coronary CTA (cCTA) rates per 100 000 Medicare beneficiaries by specialty and place of service. Card = cardiologist, ED = emergency department, HOPD = hospital outpatient department, Rad = radiologist.
Cardiac MRI (cMRI) rates per 100 000 Medicare beneficiaries by specialty and place of service. Card = cardiologist, ED = emergency department, HOPD = hospital outpatient department, Rad = radiologist.
Figure 4:
Cardiac MRI (cMRI) rates per 100 000 Medicare beneficiaries by specialty and place of service. Card = cardiologist, ED = emergency department, HOPD = hospital outpatient department, Rad = radiologist.
Myocardial perfusion imaging (MPI) rates per 100 000 Medicare beneficiaries by specialty and place of service. Card = cardiologist, ED = emergency department, HOPD = hospital outpatient department, Rad = radiologist.
Figure 5:
Myocardial perfusion imaging (MPI) rates per 100 000 Medicare beneficiaries by specialty and place of service. Card = cardiologist, ED = emergency department, HOPD = hospital outpatient department, Rad = radiologist.
Cardiac PET (cPET) rates per 100 000 Medicare beneficiaries by specialty and place of service. Card = cardiologist, HOPD = hospital outpatient department, Rad = radiologist.
Figure 6:
Cardiac PET (cPET) rates per 100 000 Medicare beneficiaries by specialty and place of service. Card = cardiologist, HOPD = hospital outpatient department, Rad = radiologist.
Overall cardiac imaging rates per 100 000 Medicare beneficiaries by noninvasive imaging modality. A log10 scale was used for rates to separate the differences between the cPET, cCTA, and cMRI trendlines. TTE, TEE, and SE were combined (Echo) given the small numbers of TEE and SE. The 2010 to 2019 percentage changes per modality are listed. SE = stress echocardiography, TEE = transesophageal echocardiography, TTE = transthoracic echocardiography.
Figure 7:
Overall cardiac imaging rates per 100 000 Medicare beneficiaries by noninvasive imaging modality. A log10 scale was used for rates to separate the differences between the cPET, cCTA, and cMRI trendlines. TTE, TEE, and SE were combined (Echo) given the small numbers of TEE and SE. The 2010 to 2019 percentage changes per modality are listed. SE = stress echocardiography, TEE = transesophageal echocardiography, TTE = transthoracic echocardiography.
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References

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