Nonradiologists Have Binged on Musculoskeletal Ultrasound

Medicare-paid musculoskeletal (MSK) ultrasound volume more than tripled from 2000 to 2009. But even that meteoric rise pales in comparison to the MSK ultrasound boom among nonradiologists - especially podiatrists.

That’s according to an article published February 1 in the Journal of the American College of Radiology by Richard E. Sharpe, MD, MBA, of Thomas Jefferson University Hospital in Philadelphia, Penn.

MSK ultrasound provides a less-expensive alternative to magnetic resonance imaging (MRI) for imaging muscles, tendons, ligaments, joints and soft tissue throughout the body. But some insurance providers have expressed concern about increased MSK ultrasound use, possibly facilitated by the low cost and ready availability of the technology.

The study’s data seems to back them up. Data was obtained from the CMS Physician/Supplier Procedure Summary Master Files from 2000 to 2009, and records were extracted for procedures for extremity non-vascular ultrasound. Researchers analyzed annual volume by provider type using specialties, practice settings and geographic regions where the studies were performed.

In 2000, Medicare reimbursed 56,254 MSK ultrasound studies, which increased to 233,964 in 2009. That’s a rise of 316 percent. Radiologists performed the largest number of MSK ultrasound studies in 2009 - 91,022 - an increase from 40,877 in 2000. But podiatrists were close behind, doing 76,332 studies, up from just 3,920 in 2000. That’s a more than 18-fold increase. By 2009, podiatrists performed 32.6 percent of all MSK ultrasounds, up from 7 percent of them in 2000, the researchers found.

Overall, private office MSK ultrasound procedures increased from 19,372 in 2000 to 158,351 in 2009 (up 717 percent). In 2009, podiatrists performed the largest number of private office procedures (75,544) and accounted for 51.5 percent of the total private office growth from 2000 to 2009. Radiologist private office procedures totaled 19,894 in 2009, accounting for 9.2 percent of the total private office MSK ultrasound growth.

Rheumatologists accounted for 22,581 procedures in 2009, compared with 176 in 2000 (up 12,730 percent). Primary care physicians accounted for 13,271 procedures in 2009 and 4,675 in 2000 (up 184 percent). All other providers accounted for 30,758 procedures in 2009, up from 7,606 in 2000 (a 304 percent increase).

“It is possible, particularly in a slow economy, that MSK ultrasound examinations are being performed more frequently to subsidize ultrasound equipment that has already been procured,” the authors wrote. “When imaging equipment has already been purchased and is idle in practice settings, it may become used for situations and indications for which it was not previously perceived as necessary. These situations may not necessarily yield a patient benefit but do increase the costs of delivering health care.”