RESPONSES TO A PAYMENT POLICY DENYING PROFESSIONAL CHARGES FOR DIAGNOSTIC-IMAGING BY NONRADIOLOGIST PHYSICIANS

Objective.-To assess the impact of a payment policy denying reimbursem ent for the imaging-related professional services of nonradiologist ph ysicians by comparing the use of and expenditures for diagnostic imagi ng examinations before and after implementation of the policy. Design. -Retrospective economic evaluation of claims and expenditures for diag nostic imaging examinations filed by physicians practicing in the 20 U S counties having the greatest number of United Mine Workers of Americ a Health and Retirement Funds (hereafter referred to as Funds) benefic iaries. Setting.-Insurance claims database of Funds beneficiaries, mos t of whom are elderly and live in rural communities and small towns. I ntervention.-The January 1, 1993, implementation of a reimbursement po licy denying payment of professional claims for diagnostic imaging of nonradiologist physicians. Main Outcome Measures.-Numbers and types of eligible claims and Funds payments for diagnostic imaging examination s during the year before and after the intervention, normalized for ch anges in the number of beneficiaries. Results.-Despite the rejection o f $811 466 in claims disallowed by the policy, the Funds paid 12% more for diagnostic imaging performed in the 20 counties we studied during 1993 than during 1992. The Funds reimbursed 41% more claims per benef iciary for diagnostic imaging in 1993 than in 1992 (t=-8.03, P<.0001). The absolute number of professional claims per beneficiary increased more than did technical or global claims. Conclusions.-Despite a payme nt policy designed, in part, to reduce the Funds' imaging-related expe nditures, the physicians we studied filed more claims, leading to grea ter expenditures. An increased number of self-referred technical claim s and greater referral to hospital radiology departments likely accoun t for most of the observed increases in utilization and costs.