The rise of secondary imaging interpretations

A new Harvey L. Neiman Health Policy Institute study assesses the increased growth of secondary interpretations of diagnostic imaging examinations in the Medicare population. The study is publishing online in the Journal of American College of Radiology (JACR).

Rosenkrantz and team used aggregate Part B fee-for-service claims frequency and payment data from the Medicare Physician/Supplier Procedure Summary Master Files for 2003 to 2016. Billed and denied services volumes were calculated and compared across modality and body region service families.

Seven service families showed a compound annual growth rate from 2003 to 2016 of >20%. For select high-volume service families, which include chest radiography and fluoroscopy [R&F], brain MRI, and abdominal and pelvic CT, relative growth in billed secondary interpretation services exceeded that for primary interpretations. In 2016, body region and modality service families with the most billed secondary interpretations were chest R&F, abdominal and pelvic R&F, brain CT, extremity R&F, abdominal and pelvic CT, and chest CT. All service families had secondary interpretation denial rates <25% in 2016.

"Among Medicare beneficiaries, the frequency of billed secondary interpretation services for diagnostic imaging services increased from 2003 to 2016 across a broad range of modalities and body regions, often dramatically," said Andrew Rosenkrantz, MD, MPA, professor and director of health policy in the department of radiology at NYU Langone Health and a Neiman Institute affiliate research fellow. "Contrary to conventional wisdom, denial rates for secondary interpretation services are now uniformly low, with denial rates of less than 10% for many imaging service families, comparable with previously reported denial rates for primary interpretations."

"Increasing referring physician demand for, and payer acceptance of, secondary interpretation services affirms the unique value of subspecialized practices that offer these services," said study senior author 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 senior affiliate research fellow at the Neiman Institute. "As CMS continues to seek input on appropriate coverage for these services, these findings suggest increasing clinical demand for and payer acceptance of these value-added radiologist services.