Medicare payments for noninvasive diagnostic imaging are now higher to nonradiologist physicians than to radiologists

Purpose: Radiologists have always been considered the physicians who "control" noninvasive diagnostic imaging (NDI) and are primarily responsible for its growth. Yet nonradiologists have become increasingly aggressive in their performance and interpretation of imaging. The purpose of this study was to track overall Medicare payments to radiologists and nonradiologist physicians in recent years.

Methods: The Medicare Part B files covering all fee-for-service physician payments for 1998 to 2008 were the data source. All codes for discretionary NDI were selected. Procedures mandated by the patient's clinical condition (eg, supervision and interpretation codes for interventional procedures, radiation therapy planning) were excluded, as were nonimaging radionuclide tests. Medicare physician specialty codes were used to identify radiologists and nonradiologists. Payments in all places of service were included. Overall Medicare NDI payments to radiologists and nonradiologist physicians from 1998 through 2008 were compared. A separate analysis of NDI payments to cardiologists was conducted, because next to radiologists, they are the highest users of imaging.

Results: In 1998, overall Part B payments to radiologists for discretionary NDI were $2.563 billion, compared with $2.020 billion to nonradiologists (ie, radiologists' payments were 27% higher). From 1998 to 2006, payments to nonradiologists increased by 166%, compared with 107% to radiologists. By 2006, payments to nonradiologists exceeded those to radiologists. By 2008, the second year after implementation of the Deficit Reduction Act, payments to radiologists had dropped by 13%, compared with 11% to nonradiologists. In 2008, nonradiologists received $4.807 billion for discretionary NDI, and radiologists received $4.638 billion. Payments to cardiologists for NDI increased by 195% from 1998 to 2006, then dropped by 8% by 2008.

Conclusions: The growth in fee-for-service payments to nonradiologists for NDI was considerably more rapid than the growth for radiologists between 1998 and 2006. Then, by the end of 2008, 2 years after the implementation of the Deficit Reduction Act, steeper revenue losses had been experienced by radiologists. The result was that by 2008, overall Medicare fee-for-service payments for NDI were 4% higher to nonradiologists than they were to radiologists.