Imaging utilization and costs vary greatly at the county level, far more than at the state level, according to a new study.
The research, conducted by the Harvey L. Neiman Health Policy Institute and published online in the Journal of the American College of Radialogy, assessed the relationships between county-level variation in Medicare beneficiary imaging resource consumption and measures of population economic status.
The research team used the 2013 Centers for Medicare & Medicaid Services Geographic Variation Public Use File and found up to a 14-fold variation at the county level in Medicare beneficiary imaging utilization and program costs, compared to a four-fold variation at the state level.
Andrew Rosenkrantz, M.D., lead study author and a Neiman Institute affiliate research fellow, and his team also used the County Health Rankings and Roadmaps database to identify county-level measures of population economic status. They found that county-level unemployment and uninsured rates among those under the age of 65 within the county were independently associated with greater imaging resource consumption in that county’s Medicare beneficiaries. Neither measure was anticipated to directly apply to a largely older and retired Medicare population.
“These associations suggest that local indigenous socioeconomic factors—ones outside the scope of traditional beneficiary-focused policy activities—influence Medicare imaging use, said Rosenkrantz, an associate professor of radiology at NYU Langone Medical Center, in an announcement about the study findings.
“In view of our findings, policy efforts to standardize and reduce variation in imaging intensity across the country should consider the high variability existing at county-level geographic units, and focus less on national 'one size fits all' approaches,” said Richard Duszak, M.D., professor and vice chair for health policy and practice in the department of radiology and imaging sciences at Emory University and affiliate senior research fellow at the Harvey L. Neiman Health Policy Institute. “Future efforts to optimize Medicare imaging use should consider the influence of public health measures that are not always accounted for in policy-focused health services research.”