Trends in the Utilization of Medical Imaging From 2003 to 2011: Clinical Encounters Offer a Complementary Patient-Centered Focus Martey S. Dodoo, PhD, Richard Duszak Jr, MD, Danny R. Hughes, PhD Purpose: The aim of this study was to investigate trends in utilization and spending for medical imaging, using medical visits resulting in imaging as a novel metric of utilization. Methods: Utilization and spending for medical imaging were examined using (1) Medicare Part B claims data from 2003 to 2011 to measure per-enrollee spending and (2) household component events data on the elderly Medicare-age population from the Medical Expenditure Panel Survey from 2003 to 2010 to measure utilization as a function of clinical encounters. Results: Annual health spending and Medicare payments for imaging for the elderly population grew from $294 per enrollee in 2003 to $418 in 2006 and had declined to $390 by 2011. Over this entire time, however, annual medical visits by a similar Medicare-age (65 years old) population resulting in imaging trended consistently downward, from 12.8% in 2003 to 10.6% in 2011. Conclusions: Despite early growth and then more recent declines in average Medicare spending per enrollee since 2003, the percentage of patient encounters resulting in medical imaging has significantly and consistently declined nationwide. Spending alone is thus an incomplete measure of changes in the role and utilization of medical imaging in overall patient care. As policymakers focus on medical imaging, a thoughtful analysis of payment policy influencing imaging utilization, and its role in concurrent and downstream patient care, will be critical to ensure appropriate patient access. Key Words: Medical imaging, utilization visits, Medicare, PSPS Master Files, MEPS, program spending J Am Coll Radiol 2013;10:507-512. Copyright © 2013 American College of Radiology INTRODUCTION Recent studies [1-3] have attempted to draw attention to the earlier growth and subsequent recent slowing in both medical imaging utilization and Medicare program spending on imaging. In ongoing efforts to curtail health care expenditures, policymakers have tended to focus on growth before 2006, when spending on imaging grew rapidly. Most have neglected more recent declines, which could in part be attributed to the Deficit Reduction Act (DRA) of 2005 [4], which markedly reduced payments for the technical components of many imaging services. In the past few years, that single legislative effort has seemingly had an enormous impact on Medicare Part B program payments to physicians for medical imag- ing [5]. However, it is not clear what effect, if any, it has had on the utilization of those services in the context of concurrent and downstream patient care. This is particularly important because there have been subsequent additional threats to physician payments for medical imaging [6], which could have implica- tions for patient care [7]. With the more recent possi- bility of sequestration (ie, mandatory spending cuts as part of the Budget Control Act), physician payments may be further reduced [3]. Moreover, additional threats exist to Medicare payments for all physician services as part of ongoing uncertainty regarding the sustainable growth rate calculation methodology [2], which could substantively affect imaging services. A failure to understand the changes in utilization that may accompany these potential payment reductions could ultimately produce adverse effects on patient care regardless of whether the intended cost contain- ment goals are realized. Ongoing analysis of trends in medical imaging has tended to focus primarily on either utilization (most Harvey L. Neiman Health Policy Institute, Reston, Virginia. Corresponding author and reprints: Martey S. Dodoo, PhD, Harvey L. Neiman Health Policy Institute, 1891 Preston White Drive, Reston, VA 20191; e-mail: mdodoo@neimanhpi.org. © 2013 American College of Radiology 0091-2182/13/$36.00 ● http://dx.doi.org/10.1016/j.jacr.2013.02.023 507