MANAGED CARE August 2009. ©MediMedia USA
Medicare Part B covers 17 million ultrasound services provided in ambulatory settings to the tune of $2 billion, according to the Office of Inspector General (OIG) for the Department of Health & Human Services. It found a high concentration of ultrasound providers or services in certain counties. Its July report, Medicare Part B Billing for Ultrasound, suggests that this may indicate areas where Medicare’s safeguard efforts should be enhanced.
In 2007, 20 high-use counties accounted for 16 percent of Part B spending on ultrasound services despite having only 6 percent of Medicare beneficiaries, according to the report. The OIG also found 3.2 million claims with questionable characteristics that raise concerns about appropriateness.
In addition, beneficiaries in this small group of counties received a disproportionate number of services compared to beneficiaries in other counties. The OIG found that the average per-beneficiary spending on ultrasound services in the 20 high-use counties was more than three times what it was for beneficiaries in the rest of the country.
These are alarming patterns that have also been observed in the private sector, according to an America’s Health Insurance Plan’s (AHIP) white paper, Ensuring Quality Through Appropriate Use of Diagnostic Imaging, which reports that systemwide spending on high technology imaging is approaching $100 billion a year, and that it is expected to double over the next four years.
“Within our health care system, health plans often serve to identify and address emerging issues of patient safety and cost, and they set out to devise solutions to these problems,” says AHIP President Karen Ignagni. “The GAO report is a good illustration that the private sector is serving as an early warning system on critical quality, safety, and cost issues in the U.S. health care system.”
Health plans across the country have observed the trends documented in the GAO report and implemented radiology benefit management programs to address patient safety, quality, and waste.