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Patient Complexity, Subspecialization Impact Radiology List Prices

A new study by the Harvey L. Neiman Health Policy Institute finds that patient condition complexity and subspecialization are primary factors affecting list price variation for radiologist services. The researchers evaluated the 2014 Medicare Physician and Other Supplier Public Use File to identify submitted charges ("list prices") and payments for radiologists' services. The report is published online in the Journal of the American College of Radiology.

"The results found that the higher charges for radiologists' services demonstrate consistent patterns of variation and are most strongly seen for those serving higher-complexity patients," says Andrew Rosenkrantz, MD, MPA, lead study author and a Neiman Institute affiliate research fellow. "Additional higher price predictors for radiologists include having a subspecialized practice pattern, with interventional radiologists having the highest price markups."

Rosenkrantz and colleagues found that among 26,715 radiologists nationally, the mean charge-to-payment ratio was 4.2. A greater charge-to-payment ratio was most strongly predicted for those serving higher-complexity patients. A higher charge-to-payment ratio was also observed among radiologists with a teaching institutional affiliation, in larger practices, and in rural areas. Subspecialists were observed to have higher charge-to-payment ratios than generalists. Among subspecialties, the greatest charge-to-payment ratios were for breast imaging and IR.

"As price transparency initiatives expand, radiologists should be aware of how and why their list prices compare with local and national benchmarks," says coauthor Richard Duszak, Jr, MD, FACR, a professor and vice chair for health policy and practice in the department of radiology and imaging sciences at Emory University in Atlanta and senior affiliate research fellow at the Neiman Institute.