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Dramatically increased musculoskeletal ultrasound utilization from 2000 to 2009, especially by podiatrists in private offices.
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Dramatically increased musculoskeletal ultrasound utilization from 2000 to 2009, especially by podiatrists in private offices.
Sharpe RE, Nazarian LN, Parker L, Rao VM, Levin DC. J Am Coll Radiol. 2012 Feb;9(2):141-6.
Quote:
PURPOSE:
Over the past two decades, musculoskeletal (MSK) ultrasound has emerged as an effective means of diagnosing MSK pathologies. However, some insurance providers have expressed concern about increased MSK ultrasound utilization, possibly facilitated by the low cost and ready availability of ultrasound technology. The purpose of this study was to document trends in MSK ultrasound utilization from 2000 to 2009 within the Medicare population.
METHODS:
Source data were obtained from the CMS Physician/Supplier Procedure Summary Master Files from 2000 to 2009, and records were extracted for procedures for extremity nonvascular ultrasound. We analyzed annual volume by provider type using specialties, practice settings, and geographic regions where the studies were performed.
RESULTS:
In 2000, Medicare reimbursed 56,254 MSK ultrasound studies, which increased to 233,964 in 2009 (+316%). Radiologists performed the largest number of MSK ultrasound studies in 2009, 91,022, an increase from 40,877 in 2000. Podiatrists utilized the next highest number of studies in 2009, 76,332, an increase from 3,920 in 2000. Overall, private office MSK ultrasound procedures increased from 19,372 in 2000 to 158,351 in 2009 (+717%). In 2009, podiatrists performed the largest number of private office procedures (75,544) and accounted for 51.5% of the total private office growth from 2000 to 2009. Radiologist private office procedures totaled 19,894 in 2009, accounting for 9.2% of the total private office MSK ultrasound growth.
CONCLUSIONS:
The MSK ultrasound volume increase among nonradiologists, especially podiatrists, was far higher than that among radiologists from 2000 and 2009, with the highest growth in private offices. These findings raise concern for self-referral.
Re: Dramatically increased musculoskeletal ultrasound utilization from 2000 to 2009, especially by podiatrists in private offices.
I think that the podiatric community needs to urgently develop some standards, proper education and QA for sonography so that any concerns regarding financial abuse, the well documented tendency to use clinical tools simply because there is financial gain to or poor clincial reasoning are addressed. Historically US seems to have suffered its fair share of being undermined by these issues.
Conversly I think there are good arguments not to regard US in same light as other imaging modalities. We would unlikely criticise clinicians for using a newly developed validated and useful technique as part of a physical exam. I think that US is often a useful extension of the PE. It boils down to cost benefit ratio and interpretation is an important component for this.
Re: Dramatically increased musculoskeletal ultrasound utilization from 2000 to 2009, especially by podiatrists in private offices.
No surprise here- American DPM's have been all over this technology in the past decade, assisted by-"You can make an extra $3K a month by doing 5 scans a week in your office." offers from US suppliers- often doing "baseline" ultrasounds. Over utilization, anyone?
No surprise when Medicare pulls the plug. When do we learn?
Dramatically increased musculoskeletal ultrasound utilization from 2000 to 2009, especially by podiatrists in private offices.
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