More cardiology imaging services performed in hospitals instead of offices

Since the Centers for Medicare & Medicaid Services (CMS) decreased payments for some cardiology services in 2010, there has been a significant increase in the number of myocardial perfusion imaging, echocardiograms and electrocardiograms performed

Zirui Song, MD, PhD, of Massachusetts General Hospital in Boston, and colleagues published their findings online in JAMA Internal Medicine on May 26.

They noted that hospitals and health systems are purchasing physician practices to help coordinate care and improve their bargaining position with insurance companies, the government and other payers. They added that the CMS decision in 2010 to cut reimbursement encouraged physicians to perform the procedures in hospitals instead of their offices because the decreases were lower in hospitals. For instance, CMS reduced payments for an echocardiogram by 16 percent in the office and 3 percent in the hospital.

In this analysis, the researchers examined the Truven Medicare and commercial claims databases from 2007 to 2012 and measured the integration of cardiologists and hospitals. They focused on myocardial perfusion imaging, echocardiograms and electrocardiograms.

The study included 802,266 Medicare beneficiaries and 12,567,069 people with commercial insurance who were between 55 and 64 years old. Approximately 53 percent of people in both groups were females.

Between 2007 and 2009 and 2010 and 2012, the share of procedures performed in hospital outpatient departments among Medicare beneficiaries increased 5.9 percent for myocardial perfusion imaging, 3.9 percent for echocardiograms and 2.7 percent for electrocardiograms. For the commercially insured, the increases were 6.4 percent, 5.5 percent and 2.4 percent, respectively.

The researchers mentioned that prices are higher at hospitals and cited a report from the Medicare Payment Advisory Committee that found if cardiac imaging continued to migrate to the hospitals, it could cost an extra $1.1 billion per year.

President Barack Obama’s budget for 2016 proposed site-neutral payment that could save $29.5 billion over 10 years, according to Song et al.