Cardiac CT and MRI Use Are Up, But Still Lagging Behind Other Heart Studies

The number of CT and MRI cardiovascular images is rising in tandem with the number of radiologists who perform them. But, the number still remains small.

In a study published Feb. 25 in Radiology: Cardiovascular Imaging, investigators from St. Francis Hospital and Heart Center in New York laid out the details of cardiac imaging usage. This information, they said, could be used to set better reimbursement levels and design optimal training protocols.

With interest growing around implementing both cardiovascular CT and MRI for standard exams, there is a need for greater information about how these studies are being used and which providers are conducting them, they added.

“A clear understanding of the current state of cardiovascular MRI and CT in the United States would guide training recommendations and reimbursement and, in the future, affect clinical practice and use,” said James Goldfarb, Ph.D., cardiovascular imaging scientist, and Jonathan Weber, MPH, research analyst.

For their study, the co-authors pulled 2012 to 2017 data from Medicare Part B physician payments in the Provider Utilization and Payment Data Physician and Other Supplier Public Use Files. In addition to focusing on the number of CT and MRI exams, as well as the number of providers conducting them, Goldfarb and Weber also examined reimbursement and provider sex and location.

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Based on their analysis, they determined that use of cardiovascular CT and MRI climbed during the six-year period by 75.5 percent for MRI and 97.4 percent for CT. However, these studies were overshadowed by nuclear medicine and echocardiography.

In addition, they identified changes among providers. By 2017, 582 physicians provided MRI, an 84.8-percent increase. For CT, the number of physicians was 1,645 -- an increase of 77.3 percent. The majority of providers were men, they said, and most were cardiologists or radiologists. Only 18 percent of providers offering MRI were women, as were 13.3 percent of those offering CT.

But, even though use climbed during the study, the amount of reimbursement reflected the lower implementation rates compared to other cardiovascular imaging tests. From 2012 to 2017, MRI and CT payments were $16.2 million and $55.8 million, respectively. However, reimbursement for echocardiography and nuclear medicine was much more substantial -- $5.9 billion and $4.2 billion, respectively.

Despite the lower use and reimbursement rates, radiologists still need to have these studies in their arsenal, and they must be ready to offer them when requested, said another industry expert in an accompanying editorial. It is incumbent upon the radiologist to be prepared as these scans grow in popularity, said Andrew J. Bierhals, M.D., MPH, associate professor of radiology at Washington University in St. Louis and radiologist at Mallinckrodt Institute of Radiology.

“How does this impact the radiology profession?” he wrote. “First and foremost, there will need to be enough radiologists to ensure timely care as these services are increasingly being demanded by referring physicians. Second, radiologists, including those in general practice, will need understanding and training in cardiac CT and MRI.”