Original article
Ownership or Leasing of CT Scanners by Nonradiologist Physicians: A Rapidly Growing Trend That Raises Concern About Self-Referral

https://doi.org/10.1016/j.jacr.2008.07.014Get rights and content

Purpose

The aim of this study was to examine recent nationwide trends in the ownership or leasing of computed tomographic (CT) scanners in private offices by nonradiologist physicians.

Methods and Materials

The Medicare Part B fee-for-service data sets for 2001 though 2006 were used to identify all CT scans performed in nonhospital, private-office settings. Ownership or leasing of CT scans was determined by tabulating all global and technical-component-only claims. Professional-component claims were excluded. The specialty of the owner or lessee was determined using Medicare's physician specialty codes. Procedure volume trends and growth rates among all nonradiologist physicians as a group were compared with those among radiologists. Individual specialty volume trends and growth rates were also studied.

Results

From 2001 to 2006, Medicare private-office CT scan volume in facilities owned by radiologists increased by 85%. CT scan volume in facilities owned or leased by nonradiologist physicians as a group increased by 263%. The nonradiologic specialties with the largest volumes in 2006 were primary care (192,255 scans), internal medicine subspecialties other than cardiology and medical oncology (184,991 scans), urology (125,850 scans), cardiology (104,739 scans), and medical oncology (61,976 scans). Excluding CT scans performed in independent diagnostic testing facilities (for which physician ownership cannot be determined), nonradiologists' private-office CT market share rose from 16% in 2001 to 28% in 2006.

Conclusions

The majority of Medicare private-office CT scans are done in facilities owned by radiologists. However, nonradiologist physicians are acquiring or leasing CT scanners in increasing numbers, and the growth trend is much more rapid among them than it is among radiologists (85% among radiologists from 2001 to 2006, compared with 263% among nonradiologists). As a result, nonradiologists' market share has increased considerably. At a time when both cost containment and reduction in radiation exposure are urgent priorities, the self-referral opportunities resulting from this trend should be of concern to payers and policymakers.

Section snippets

Materials and Methods

We used the Medicare Part B Physician/Supplier Procedure Summary Master Files for 2001 through 2006. These files provide utilization data on all Current Procedural Terminology®, Fourth Edition, codes for the more than 37 million fee-for-service Medicare beneficiaries in the United States. For each code, the files provide annual procedure volume; place of service where the examinations were carried out; the specialties of the physicians filing the claims; identifiers to indicate whether claims

Results

As shown in Table 1, Medicare private-office CT volume in 2001 was 1,500,316. This increased to 3,366,616 in 2006, a 124% increase. The component figures are shown for radiologists, all nonradiologist physicians as a group, and IDTFs. Between 2001 and 2006, radiologists' private-office volume increased by 85%, compared with a 263% increase among nonradiologists and a 231% increase among IDTFs. Figure 1 plots the volume for nonradiologists for each of the 6 years. Note a continuous upward trend,

Discussion

Our results show that the trend in CT acquisition or leasing by nonradiologist physicians is similar to that which is occurring with MRI [11]. Although the majority of CT scans in private offices are done by radiologists, the growth rate from 2001 to 2006 among nonradiologists was far higher (85% for the former, 263% for the latter). The result has been that the private-office CT market share of nonradiologists rose from 16% in 2001 to 28% in 2006.

A recent study by Mitchell [10] examined growth

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This study was supported in part by a grant from the American College of Radiology, Reston, Virginia.

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