Nonradiologists Still Do More Double Chest Scans

May 18, 2015

WASHINGTON, DC-Pre- and postcontrast chest CTs are done more often by nonradiologists than radiologists.

The use of combined pre- and postcontrast chest CTs among radiologists dramatically decreased when associated with efficiency metrics, but the reduction in use was not as quick among nonradiologists, according to a presentation at ACR 2015, held this week in Washington, DC.

Researchers from the University of Colorado, Denver, The Harvey L. Neiman Health Policy Institute and American College of Radiology in Reston, VA, and The Harvey L. Neiman Health Policy Institute, Atlanta, GA, sought to analyze the trends of utilization of “double scans,” CT studies of the chest, performed both with and without contrast, which have been the focus of hospital outpatient cost- and radiation-reduction metrics by the Center for Medicare and Medicaid Services (CMS) since legislation in 2006.

The researchers identified national claims for CT examinations of the chest (with contrast, without contrast, and both pre- and postcontrast) using Medicare Physician Supplier Procedure Summary Master Files from 2001 through 2012. Changes in the use of double scans were analyzed overall, by provider specialty, and by site of service.

The results show a quicker drop in use among radiologists over nonradiologists:

 Double scan rates before 2006Double scan rates in 2012Decline rate between 2001 and 2012
Radiologists5.9% to 5.2%2.8%52.8%
Nonradiologists5.6% to 6.3%4.1%28.1%

 

 

In the private office setting, double scan rates increased from 2001 through 2007 from 6.9% to 8.0%, and decreased to 5.3% by 2012, representing an overall 23.3% decline.

In all other major sites, declines occurred steadily and at a greater pace:

 Double scan rate dropDecrease
Inpatient hospital5.4% to 1.9%–65.5%
Outpatient hospital6.0% to 2.8%–53.5%
Emergency department6.5% to 1.9%–71.0%

 

 

 

 

 

 

The researchers concluded that there was a dramatic reduction among radiologists in the use of double scans since imaging efficiency metrics were introduced, but while nonradiologists also decreased use, it was not as quick or as dramatic a decline. “Overall double scan rates remain highest in the private office setting, where declines have been much slower than in all other major sites of service,” they wrote.