Medicare Payments Now Higher for Nonradiologists

Nonradiologists are now paid more by Medicare than radiologists for non-invasive medical imaging, according to a new study that highlights concerns about self-referrals.

Growth in fee-for-service payments to nonradiologists (especially cardiologists) between 1998 and 2006 was “considerably more rapid” than for radiologists, said David C. Levin, MD, lead author of the study in the January issue of the Journal of the American College of Radiology.

“Because most imaging by nonradiologists is self-referred, whereas radiologists generally do not have the opportunity to self-refer, this should be of interest and concern to policymakers and payers,” wrote Levin and co-authors Vijay M. Rao, MD, Laurence Parker, PhD, Andrea J. Frangos, MS, and Jonathan H. Sunshine, PhD.

In the review of Medicare Part B files, researchers found that radiologists’ overall payments increased by 107 percent during that time, compared with a 166 percent increase for nonradiologists. In 1998, radiologists’ payments were $2.56 billion, peaking at $5.3 billion in 2006. Payments dropped in 2007, then increased the following year to $4.65 billion.

For nonradiologists, payments in 1998 were $2.02 billion, peaking at $5.38 billion in 2006, then dropping and rising again to $4.81 billion in 2008. When they looked just at cardiologists, researchers found that growth in payments was 195 percent among cardiologists, and 137 percent among other physicians.

By 2008, payments to nonradiologists were 4 percent higher than those to radiologists, the study found.

“These data indicate that radiologists no longer can be judged to be the ones primarily responsible for cost increases, as some have alleged in the past,” the authors wrote.

Researchers attribute the findings to a rapid growth in fee-for-service payments to nonradiologists between 1998 and 2006, followed by losses to radiologists in 2007 when the Deficit Reduction Act took effect.