It is well known that entrepreneurial orthopedic surgery groups are purchasing their own MRI units. Our purpose was to compare trends in MRI reimbursement paid to orthopedic surgeons (OSs) and radiologists, and to determine how much of a role OSs have in the practice of MR imaging.
METHOD AND MATERIALS
The nationwide Medicare Part B fee-for-service databases were searched for all MRI CPT-4 codes between 1997 and 2002. These MRI codes were grouped into 5 categories: body, cardiovascular, cranial, musculoskeletal, and spinal. The Medicare databases provide information on the specialty of the physician providers and on payments for all claims for physician services. Using the Medicare physician specialty codes, we determined the reimbursements paid by Medicare for all MRI-related professional component, technical component, and global claims submitted by OSs and radiologists. Trends between 1997 and 2002 were also assessed.
In 2002, radiologists received total Medicare reimbursements of $976,350,382 for all MRI services, which represented a 99% increase since 1997. Of those dollars paid to radiologists in 2002, musculoskeletal (MSK) MRI accounted for $141,480,579 (+129% since 1997) and spine MRI accounted for $343,393,366 (+86% since 1997). In 2002, OSs received total Medicare payments for all MRI services of $30,989,131 (+599% since 1997). Of these dollars, MSK MRI accounted for $17,775,833 (+713% since 1997). Spine MRI accounted for $11,598,022 (+539% since 1997). MRI payments to OSs as a percent of MRI payments to radiologists in 2002 were as follows: 3% of all MRI payments; 13% of MSK MRI payments; 3% of spine MRI payments.
Reimbursements paid to OSs for all MRI services were only 3% of the amount of MRI payments to radiologists in 2002. However, payments to OSs for MSK MRI were 13% of such payments to radiologists. Between 1997 and 2002, the rates of growth in reimbursements to OSs for total MRI, MSK MRI, and spine MRI were far higher than the rates of growth for radiologists. Since MRI by OSs is performed in a largely self-referred setting, this raises the concern that if the trend continues, it could become a significant cost driver for the Medicare program.