Claims-based classification system could facilitate payer identification of academic radiologist sub

March 20, 2017

A new study by the Harvey L. Neiman Health Policy Institute presents initial validation of a novel payer claims-based system using imaging examination modality and body region for classifying radiologists' subspecialty. The study is published online in the American Journal of Roentgenology (AJR).

In carrying out their work, the researchers leveraged the Neiman Imaging Types of Service (NITOS) coding platform, an open source classification system recently developed by Neiman Institute researchers that allows users to readily extract utilization and cost data to examine the role and value of medical imaging. NITOS provides a comprehensive classification of all Healthcare Common Procedure Coding System (HCPCS) codes for non-invasive diagnostic imaging professional services, mapping each code to an imaging modality, body region, and, when relevant, a specialty area of focus.

"Using Medicare public use files, we identified 33,118 self-designated radiologists, and through a manual and laborious search, we further identified 1,860 of those working at the top 20 National Institutes of Health-funded academic radiology departments across the country," said Richard Duszak, MD, FACR, professor and vice chair for health policy and practice in the department of radiology and imaging sciences at Emory University and affiliate senior research fellow at the Neiman Institute. "Medicare claims for those radiologists were NITOS-mapped by subspecialty, and that mapping was compared to their departmental website self-designated subspecialty area."

According to Duszak, this transparent and reproducible mapping algorithm correctly subspecialty classified 90 percent of academic radiologists. Of the other 10 percent, 6 percent had practice patterns sufficiently mixed that they could not be discretely classified, and 4 percent were erroneously classified.

"Emerging payment models are designed to more tightly link payment to quality metrics, thereby rewarding physicians who demonstrate the greatest value for their patients," noted lead author Andrew Rosenkrantz, MD, MPA, an associate professor of radiology at NYU Langone Medical Center and a Neiman Institute affiliate research fellow. "Metrics developed by the Centers for Medicare and Medicaid Services (CMS) have been the subject of considerable criticism, particularly as they apply to radiologists."

Under MACRA, CMS has developed specialty- and subspecialty-specific quality measures, from which physicians can report any six measures for their specialty/sub-specialty. However, CMS provider codes currently only differentiate diagnostic radiologists in a generic manner from nuclear medicine physicians and interventional radiologists. As such, metrics meaningful to different subspecialty diagnostic radiologists (e.g., breast imagers vs. neuroradiologists) may be vastly different. Given such concerns, CMS has indicated its intent to partner with specialty societies in developing expanded sets of subspecialty measures.

If validated through further work, the researchers note that such a classification system would allow radiologists to be mostly quality-scored based on metrics most relevant to their unique practices, and thus align new value-based payment models with the reality of subspecialty radiology care.

"If this concept could be validated more broadly, it would permit the development of subspecialty-focused quality metrics, thus broadening opportunities for subspecialty work to be appropriately acknowledged in future payment models," added Duszak.

Explore further: New research examines patients' satisfaction with their radiologists

Related Stories

New research examines patients' satisfaction with their radiologists

February 18, 2017
New research reports that most U.S. radiologists receive favorable satisfaction scores from their patients. The study, supported by research grants from the Harvey L. Neiman Health Policy Institute, is published online in ...

New research explores patients' satisfaction with their radiologists

November 29, 2016
According to a new research study, most U.S. radiologists receive favorable satisfaction scores from their patients. The abstract, funded by the Harvey L. Neiman Health Policy Institute, was presented at the 102nd Scientific ...

New study evaluates national trends in enteral access procedures

November 23, 2016
According to a new study by the Harvey L. Neiman Health Policy Institute, the last two decades have seen a substantial decline in new enteral access procedures in the Medicare population. The study, published online in the ...

Follow-up imaging significantly less when initial ED ultrasound is interpreted by radiologists than

February 22, 2017
According to new research by the Harvey L. Neiman Health Policy Institute, the use of follow-up imaging is significantly less when initial emergency department (ED) ultrasound examinations are interpreted by a radiologist ...

Report examines MACRA's impact on radiologists

December 28, 2016
A new Harvey L. Neiman Health Policy Institute series of reports explores the impact of the Medicare Access and CHIP Reauthorization Act (MACRA) of 2015, along with the Centers for Medicare and Medicaid Services' (CMS) 2016 ...

New report presents bundled payment model for breast cancer screening

August 18, 2016
According to a new report by the Harvey L. Neiman Health Policy Institute, mammography may present an opportunity for the expanded use of bundled payments in radiology. The study, published online in the Journal of the American ...

Recommended for you

Poor sleep could lead to heavier drinking in young adults, study finds

December 8, 2017
A shortened night of sleep may increase young adults' risk of heavier drinking, according to a new Yale study that assessed reciprocal variations in sleep and drinking over time in young adults.

Researchers say nutritional labeling for sodium doesn't work

December 8, 2017
Potato chips, frozen pizza, a fast food hamburger-these foods are popular in the American diet and saturated with sodium. Though eating too much can lead to high blood pressure and heart disease, 90 percent of Americans eat ...

Observation care may save more than thought

December 8, 2017
In the world of health care spending policy, it usually works that as Medicare goes so goes private insurance on matters of managing the cost and quality of care.

Screen time before bed linked with less sleep, higher BMIs in kids

December 7, 2017
It may be tempting to let your kids stay up late playing games on their smartphones, but using digital devices before bed may contribute to sleep and nutrition problems in children, according to Penn State College of Medicine ...

Mindful yoga can reduce risky behaviors in troubled youth, says research

December 7, 2017
For some young people, dealing with life stressors like exposure to violence and family disruption often means turning to negative, risky behaviors—yet little is known about what can intervene to stop this cycle.

Teen girls 'bombarded and confused' by sexting requests: study

December 7, 2017
Adolescent women feel intense pressure to send sexual images to men, but they lack the tools to cope with their concerns and the potential consequences, according to new Northwestern University research published Wednesday, ...

0 comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.