News | Radiology Imaging | March 13, 2017

Medicare Imaging Utilization and Costs Vary More at County Than State Levels

New study finds county-level unemployment and uninsured rates had greatest impact on imaging resource consumption

Neiman Health Policy Institute, HPI study, Medicare population, imaging resource consumption, state level vs. county level, JACR

March 13, 2017 — A new research study by the Harvey L. Neiman Health Policy Institute assesses relationships between county-level variation in Medicare beneficiary imaging resource consumption and measures of population economic status. The study, published online in the Journal of the American College of Radiology (JACR), found that in the Medicare population, imaging utilization and costs vary greatly at the county level, and far more than at the state level.

“Using the 2013 Centers for Medicare and Medicaid Services Geographic Variation Public Use File, we observed wide (up to 4-fold) variation in Medicare beneficiary imaging utilization and program costs at the state-level and far wider (up to 14-fold) variation at the county-level,” said Andrew Rosenkrantz, M.D., MPA, lead study author and a Neiman Institute affiliate research fellow.

Rosenkrantz and his colleagues used the County Health Rankings and Roadmaps database to identify county-level measures of population economic status. Specifically, county-level unemployment rates and rates of uninsured in those under the age of 65 within the county — both measures not anticipated to directly apply to a largely older and retiree Medicare population — were independently associated with greater imaging resource consumption in that county’s Medicare beneficiaries.

“These associations suggest that local indigenous socioeconomic factors — ones outside the scope of traditional beneficiary-focused policy activities — influence Medicare imaging use,” noted Rosenkrantz, an associate professor of radiology at NYU Langone Medical Center.

“In view of our findings, policy efforts to standardize and reduce variation in imaging intensity across the country should consider the high variability existing at county-level geographic units, and focus less on national, one-size-fits-all approaches,” said Richard Duszak, M.D., 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 Harvey L. Neiman Health Policy Institute. “Future efforts to optimize Medicare imaging use should consider the influence of public health measures that are not always accounted for in policy-focused health services research.”

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