Using Medical Claims for Policy Effectiveness Surveillance: Reimbursement and Utilization of Abdomen/Pelvis Computed Tomography Scans

Health Services Research
Michal HornýVanessa L Merker

Abstract

To quantify changes in private insurance payments for and utilization of abdominal/pelvic computed tomography scans (CTs) after 2011 changes in CPT coding and Medicare reimbursement rates, which were designed to reduce costs stemming from misvalued procedures. TruvenHealth Analytics MarketScan Commercial Claims and Encounters database. We used difference-in-differences models to compare combined CTs of the abdomen/pelvis to CTs of the abdomen or pelvis only. Our main outcomes were inflation-adjusted log payments per procedure, daily utilization rates, and total annual payments. Claims data were extracted for all abdominal/pelvic CTs performed in 2009-2011 within noncapitated, employer-sponsored private plans. Adjusted payments per combined CTs 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 CTs dropped by 5.0 percent (p < .0001). Total annual payments for combined CTs of the abdomen/pelvis decreased in 2011 despite the increased utilization. Private insurance payments for combined CTs of the abdomen/pelvis declined and utilization accelerated significantly af...Continue Reading

References

Jan 1, 1994·Health Affairs·H A Huskamp, J P Newhouse
Dec 10, 1990·Journal of Health Economics·T G McGuire, M V Pauly
Oct 25, 2000·Journal of Computer Assisted Tomography·H L NisenbaumC P Langlotz
Jun 30, 2006·The New England Journal of Medicine·John K Iglehart
Feb 28, 2008·Health Affairs·Sean KeehanUNKNOWN National Health Expenditure Accounts Projections Team
Feb 7, 2009·Radiologic Clinics of North America·Joel G FletcherCynthia H McCollough
Jan 6, 2010·Health Affairs·David C LevinLaurence Parker
Feb 5, 2010·Journal of the American College of Radiology : JACR·Ezequiel Silva
Aug 26, 2010·Radiology·William R HendeePaul E Wallner
Jan 8, 2011·Journal of the American College of Radiology : JACR·Ezequiel Silva
Apr 25, 2014·AJR. American Journal of Roentgenology·David C LevinLaurence Parker
May 13, 2014·Journal of the American College of Radiology : JACR·Michal HornýAlan B Cohen

❮ Previous
Next ❯

Citations

May 26, 2018·The Pediatric Infectious Disease Journal·Jake R MorganMari-Lynn Drainoni
Jun 7, 2021·Gynecologic Oncology·Jacqueline M MillsRebecca B Perkins

❮ Previous
Next ❯

Related Concepts

Trending Feeds

COVID-19

Coronaviruses encompass a large family of viruses that cause the common cold as well as more serious diseases, such as the ongoing outbreak of coronavirus disease 2019 (COVID-19; formally known as 2019-nCoV). Coronaviruses can spread from animals to humans; symptoms include fever, cough, shortness of breath, and breathing difficulties; in more severe cases, infection can lead to death. This feed covers recent research on COVID-19.

Blastomycosis

Blastomycosis fungal infections spread through inhaling Blastomyces dermatitidis spores. Discover the latest research on blastomycosis fungal infections here.

Nuclear Pore Complex in ALS/FTD

Alterations in nucleocytoplasmic transport, controlled by the nuclear pore complex, may be involved in the pathomechanism underlying multiple neurodegenerative diseases including Amyotrophic Lateral Sclerosis and Frontotemporal Dementia. Here is the latest research on the nuclear pore complex in ALS and FTD.

Applications of Molecular Barcoding

The concept of molecular barcoding is that each original DNA or RNA molecule is attached to a unique sequence barcode. Sequence reads having different barcodes represent different original molecules, while sequence reads having the same barcode are results of PCR duplication from one original molecule. Discover the latest research on molecular barcoding here.

Chronic Fatigue Syndrome

Chronic fatigue syndrome is a disease characterized by unexplained disabling fatigue; the pathology of which is incompletely understood. Discover the latest research on chronic fatigue syndrome here.

Evolution of Pluripotency

Pluripotency refers to the ability of a cell to develop into three primary germ cell layers of the embryo. This feed focuses on the mechanisms that underlie the evolution of pluripotency. Here is the latest research.

Position Effect Variegation

Position Effect Variagation occurs when a gene is inactivated due to its positioning near heterochromatic regions within a chromosome. Discover the latest research on Position Effect Variagation here.

STING Receptor Agonists

Stimulator of IFN genes (STING) are a group of transmembrane proteins that are involved in the induction of type I interferon that is important in the innate immune response. The stimulation of STING has been an active area of research in the treatment of cancer and infectious diseases. Here is the latest research on STING receptor agonists.

Microbicide

Microbicides are products that can be applied to vaginal or rectal mucosal surfaces with the goal of preventing, or at least significantly reducing, the transmission of sexually transmitted infections. Here is the latest research on microbicides.

Related Papers

Journal of Clinical Densitometry : the Official Journal of the International Society for Clinical Densitometry
Robert A OvermanChad L Deal
Clinical Nurse Specialist CNS
J Baradell, N Hanrahan
© 2022 Meta ULC. All rights reserved