Substantial growth in ordering of CTA exams in Medicare population

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According to a new study by the Harvey L. Neiman Health Policy Institute, the last 13 years have seen a substantial growth in the ordering of computed tomography angiography (CTA) examinations in the Medicare population, particularly in the emergency department setting.

While radiologists generally do not order imaging exams, the study, published online in the Journal of Vascular and Interventional Radiology (JVIR), found that radiologists remain the dominant providers of CTA exams, with the chest being the most common body region imaged with CTA. “Using aggregated Medicare fee-for-service claims data from 2001 through 2014, we identified growth in overall volumes in CTA services and per beneficiary utilization of CTA exams,” said Neiman Institute affiliate research fellow and lead study author Anand M Prabhakar. “Although this trend was present for all types of CTA services and in all major sites of service, we found that growth was greatest for chest CTA and for CTA services in the emergency department.”

Prabhakar, a Harvard radiologist, and his colleagues found that between 2001 and 2014, total CTA services in the Medicare FFS population grew from 64,846 to 1,709,088. They also found that the total number of CTA exams per 1,000 Medicare enrollees continuously increased from 2.1 in 2001 to 47.6 in 2013. Chest CTA utilisation per 1,000 Medicare enrollees increased the most, rising year over year from 1.2 in 2001 to 25.4 in 2013. CTA services grew most rapidly in the ED setting, with the percentage of studies performed annually in emergency departments increasing from 11% in 2001 to 28% in 2014. By far, the largest growth in CTA services involved the chest, increasing from 36,984 in 2001 to 914,086 in 2014.

“CTA growth in emergency departments continues to outpace all other sites of service. With further advances in CT technology such as dual source imaging, we anticipate this trend to continue as CTA exams continue to provide information previously only available through catheter directed angiography,” noted Prabhakar.

“These findings underscore the importance of ongoing high quality vascular imaging training for both diagnostic and interventional radiologists,” noted Richard Duszak, professor and vice chair for health policy and practice in the department of Radiology and imaging sciences at Emory University and senior research fellow at the Harvey L Neiman Health Policy Institute. “As new interventional radiology residency programmes are now being implemented, it will be important for programmes to ensure that their trainees achieve high levels of proficiency in their vascular cross sectional imaging skills to meet this growing need.”