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CLINICAL RESEARCH: CARDIAC IMAGING

Evolving Trends in the Use of Echocardiography

A Study of Medicare Beneficiaries

Alan S. Pearlman, MD, FACC^_*,_*, Thomas Ryan, MD, FACC, Michael H. Picard, MD, FACC and Pamela S. Douglas, MD, MACC^,a

^_* Division of Cardiology, Department of Medicine, University of Washington Medical Center, Seattle, Washington
Division of Cardiovascular Medicine, Duke University Medical Center, Durham, North Carolina
Division of Cardiology, Massachusetts General Hospital, Boston, Massachusetts.

Manuscript received May 30, 2006; revised manuscript received February 2, 2007, accepted February 5, 2007.

^_* Reprint requests and correspondence: Dr. Alan S. Pearlman, Division of Cardiology, Box 356422, University of Washington School of Medicine, 1959 NE Pacific Street, Seattle, Washington 98195. (Email: apearlmn{at}u.washington.edu).

Objectives: We studied the use of echocardiography among Medicare beneficiaries between 1999 and 2004 to determine the rate of growth in these services and evaluate the drivers of growth.

Background: Concerned about increasing health care costs, federal and private payers have highlighted growth in diagnostic imaging studies and begun to develop approaches to curb this growth.

Methods: Medicare Part B Physician/Supplier Procedure Summary Master File and enrollment data from 1999 to 2004 were reviewed. Total Medicare carrier-paid spending for echocardiography services was determined from procedure volumes and allowed charges. The 5% standard analytic file of physician claims was used to evaluate geographic variations in use and to document the specialties of physicians who request and those who interpret echocardiograms.

Results: Between 1999 and 2004, echocardiography services grew at a rate similar to that for all medical services subject to Medicare’s sustainable growth rate (SGR) calculation. Increasing provision of echocardiograms in physicians’ offices contributed to increased spending under the SGR. Accounting for this shift, actual annualized per capita growth in echocardiography was 7.7%. Variations in the prevalence of heart disease contributed to geographic variations in use. Although cardiologists were the most common providers of echocardiographic services, primary care physicians ordered the majority of these diagnostic procedures.

Conclusions: Growth in the use of echocardiography is in keeping with the general growth in medical services. Nonetheless, physicians who order echocardiograms and those who provide them must work together to ensure that in the future these diagnostic services are used appropriately and not excessively.

Abbreviations and Acronyms   BETOS = Berenson-Eggers Type Of Service   CMS = Centers for Medicare and Medicaid Services   HCPCS = Healthcare Common Procedure Coding System   HF = heart failure   RVU = relative value unit   SGR = sustainable growth rate