Pre-Pandemic Trends of Inpatient Radiology Evaluation and Management Claims: National Usage and Reimbursement Trends from 2010 to 2018

Purpose: To evaluate the usage and reimbursement trends of inpatient evaluation and management (E&M) claims filed by radiologists among Medicare beneficiaries from 2010 to 2018.

Methods/Materials: Medicare claims from 2010 to 2018 were extracted from the Medicare Part B Physician/Supplier Procedure Summary Master File for a select amount of inpatient evaluation and management (E&M) services including initial hospital care, consultations, and subsequent encounters. The data was filtered to only include claims from radiologists and interventional radiologists in the inpatient hospital setting. The total volume and reimbursements were analyzed in aggregate and service type.

Results: Aggregate inpatient E&M claims decreased from 2010 to 2018 by 19.5% from 58,598 to 47,198.

There was a 10.1% decrease in initial care services from 16,012 to 14,388 and a 23.0% decrease in subsequent encounters from 42,586 to 32,810. All inpatient consultation claims were denied. Subset analysis demonstrated decreased volumes for nearly all services rendered except low-complexity initial hospital care encounters, which showed a 35.9% increase in volume from 3,399 to 4,618.

Aggregate reimbursement from inpatient E&M services decreased by 18.5% from $4,064,693.67 to $3,312,089.98. Average reimbursement per service minimally increased from $69.37 to $70.18.

Conclusions: Inpatient E&M claims decreased by 19.5% from 58,598 to 47,198 with only low complexity admissions increasing in volume during this period. Given more recent increases in valuation for E&M service proposed by Centers for Medicare and Medicaid Services (CMS) and greater focus on interventional radiology as a clinically-focused specialty, inpatient E&M services represent an opportunity for revenue and clinical growth for interventional radiology practices.