Radiologists consolidate bone mineral density turf

Radiologists have seized control of imaging to measure bone mineral density, increasing their turf by 20% in a six-year period, according to researchers from Thomas Jefferson University.

Dual x-ray absorptiometry has become the gold standard for BMD analysis. The Bone Mass Measurement Act of 1998 provided reimbursement for physicians interpreting DXA scans.

Most of those Medicare dollars now march radiology's way, according to a study published in the August issue of the Journal of the American College of Radiology.

Inch by inch, radiologists have come to dominate the procedure, said principal investigator Dr. Charles M. Intenzo, a professor of radiology at Jefferson.

Intenzo and colleagues reviewed the Medicare Part B national database listing all DXA procedures performed between 1996 and 2002. They found that the number of scans performed on all Medicare patients had increased fourfold. During the same period, the percentage of exams performed by radiologists jumped from less than a third to almost half.

Radiologists and nonradiologists performed 30% and 70%, respectively, of the more than 500,000 DXA exams performed in 1996. By 2002, the total number of DXA scans had increased to more than two million, and 45% of them had been performed by radiologists.

The total number of DXA scans performed on Medicare recipients between 1996 and 2002 increased by 338%. The number of exams read by radiologists, nonradiologists, and multispecialty groups increased by 553%, 245%, and 248%, respectively.

The clinical literature shows a significant increase in the number of self-referrals by nonradiologists, particularly endocrinologists, rheumatologists, orthopedists, general internists, and gynecologists. The colossal DXA utilization increase among radiologists for the same patient population shows a clearly favorable trend for the specialty, Intenzo said.

The researchers speculated that low reimbursement for DXA is a reason why the number of nonradiologists performing the exam has not kept pace. Medicare reimbursement rates for a spine/hip DXA scan in Pennsylvania, for instance, are $135.69 for the technical component and $16.06 for the professional component.

"Radiologists must provide quality service as an incentive for continuing patient referral from clinicians," the researchers said.

For more information from the Diagnostic Imaging archives:

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Ultrasound-based device can diagnose bone loss in space

Imaging use grows as osteoporosis treatment becomes common

Alternative osteoporosis tools could challenge DXA exam

Managing osteoporosis: a nonradiologist's view