Reimbursement cuts and a controversial 2005 law might have taken their toll on imaging services, according to a new study.

For the first time in more than a decade, the volume of advanced imaging services, such as MRI scans, has dropped for Medicare beneficiaries, according to a report released Wednesday.

Advanced imaging volumes dipped only a smidgen, about one-tenth of 1 percent, from 2008 to 2009, after steadily increasing every year from 1999. But the amount for all imaging services studied declined 7.1 percent in 2009, the report said.
Pocketbooks weren't spared, either. Spending on imaging, overall, fell about 2.1 percent, from $12 billion in 2008 to $11.8 billion in 2009. However, spending for advanced imaging saw a 1.2 percent uptick, although still remaining below its 2006 peak.

"It's pretty clear the years of rapid growth [of imaging] seem to have come to an end at this point in time," said Don Moran, with The Moran Company, which prepared the report on behalf of Access to Medical Imaging Coalition (AMIC), a lobby for patients, doctors and device manufacturers.

The report analyzed services billed to Medicare Part B carriers under the physician fee schedule from 1999-2009. Advanced imaging includes MRI, CT, PET/CT, PET and nuclear medicine.

It found, by looking at the whole 11-year period, the compound annual growth rate for the total imaging volume was 4 percent, and for spending it was 7.3 percent.

But after 2005-2006, the growth rate of volume began to sputter, and by 2007, many numbers were trending downwards. That year, the Deficit Reduction Act of 2005 took effect, which slashed non-hospital imaging reimbursements. Spending on advanced imaging services fell almost 20 percent between 2006 and 2007, according to the report.

For the most recent year, 2009, the total volume of CT, MR and other advanced imaging was 37 million, down 100,000 from the year before. Spending was about $4.8 billion in 2009, compared with around $4.7 billion in 2008. However, both figures are well below the $5.7 billion high of 2006.

Cause for concern?

The dip, though small, has worried some radiologists.

"We are very concerned with this decline, because first of all, the incidence and prevalence of disease in the population has not declined, and secondly because the Medicare population is increasing," Dr. John A. Patti, chair of the American College of Radiology Board of Chancellors, told reporters in a call.

Spending per beneficiary began to decline in 2006 for patients getting exams in doctors' offices and imaging centers. However, spending per patient remained steady for those being treated at hospitals, which were not the target of the DRA provisions affecting imaging.

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