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Using Medical Claims for Policy Effectiveness Surveillance: Reimbursement and Utilization of Abdomen/Pelvis Computed Tomography Scans
Author(s) -
Horný Michal,
Morgan Jake R.,
Merker Vanessa L.
Publication year - 2015
Publication title -
health services research
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.706
H-Index - 121
eISSN - 1475-6773
pISSN - 0017-9124
DOI - 10.1111/1475-6773.12293
Subject(s) - pelvis , medicine , abdomen , reimbursement , payment , radiology , emergency medicine , finance , business , health care , economics , economic growth
Objective To quantify changes in private insurance payments for and utilization of abdominal/pelvic computed tomography scans ( CT s) after 2011 changes in CPT coding and Medicare reimbursement rates, which were designed to reduce costs stemming from misvalued procedures. Data Sources TruvenHealth Analytics MarketScan Commercial Claims and Encounters database. Study Design We used difference‐in‐differences models to compare combined CT s of the abdomen/pelvis to CT s of the abdomen or pelvis only. Our main outcomes were inflation‐adjusted log payments per procedure, daily utilization rates, and total annual payments. Data Extraction Methods Claims data were extracted for all abdominal/pelvic CT s performed in 2009–2011 within noncapitated, employer‐sponsored private plans. Principal Findings Adjusted payments per combined CT s of the abdomen/pelvis dropped by 23.8 percent ( p < .0001), and their adjusted daily utilization rate accelerated by 0.36 percent ( p = .034) per month after January 2011. Utilization rate of abdominal‐only or pelvic‐only CT s dropped by 5.0 percent ( p < .0001). Total annual payments for combined CT s of the abdomen/pelvis decreased in 2011 despite the increased utilization. Conclusions Private insurance payments for combined CT s of the abdomen/pelvis declined and utilization accelerated significantly after 2011 policy changes. While growth in total annual payments was contained in 2011, it may not be sustained if 2011 utilization trends persist.