Recent Trends in Imaging Use in Hospital Settings: Implications for Future Planning

Purpose: To compare trends in utilization rates of imaging in the three hospital-based settings where imaging is conducted.

Methods: The nationwide Medicare Part B databases for 2004-2014 were used. All discretionary noninvasive diagnostic imaging (NDI) CPT codes were selected and grouped by modality. Procedure volumes of each code were available from the databases and converted to utilization rates per 1,000 Medicare enrollees. Medicare's place-of-service codes were used to identify imaging examinations done in hospital inpatients, hospital outpatient departments (HOPDs), and emergency departments (EDs). Trends were observed over the life of the study.

Results: Trendlines were strongly affected by code bundling in echocardiography in 2009, nuclear imaging in 2010, and CT in 2011. However, even aside from these artifactual effects, important trends could be discerned. Inpatient imaging utilization rates of all modalities are trending downward. In HOPDs, the utilization rate of conventional radiographic examinations (CREs) is declining but rates of CT, MRI, echocardiography, and noncardiac ultrasound (US) are increasing. In EDs, utilization rates of CREs, CT, and US are increasing. In the 3 years after 2011, when no further code bundling occurred, the total inpatient NDI utilization rate dropped 15%, whereas the rate in EDs increased 12% and that in HOPDs increased 1%.

Conclusions: The trends in utilization of NDI in the three hospital-based settings where imaging occurs are distinctly different. Radiologists and others who are involved in deciding what kinds of equipment to purchase and where to locate it should be cognizant of these trends in making their decisions.