Cardiac Imaging Trends from 2010 to 2019 in the Medicare Population

Purpose: To evaluate changes in utilization of cardiac imaging-transthoracic, transesophageal, and stress echocardiography (TTE, TEE, and SE), coronary CT angiography (cCTA), cardiac MRI (cMRI), myocardial perfusion imaging (MPI), and cardiac positron emission tomography (cPET). Materials and Methods: The 2010-2019 Physician/Supplier Procedure Summary files were used to find imaging utilization per 100 000 Medicare beneficiaries. Global and professional claims were aggregated, representing total interpretive services. Specialty codes identi-fied provider specialty. Results were stratified by physician offices, hospital outpatient departments (HOPDs), inpatient setting, and the emergency department. Results: From 2010 to 2019, there was a partial shift from cardiologist offices to the HOPD for TTE (office: -23%; HOPD: +107%) and SE (office: -44%; HOPD: +11%). Cardiologist cCTA also shifted from the office (-57%) to the HOPD (+211%). Radiologist -performed cCTA grew in all locations but most in the HOPD (+355%), with radiologists performing more cCTA than cardiologists in all settings. cMRI rates remain low but rose in the HOPD for both cardiologists (+209%) and radiologists (+207%). Cardiologist MPI rates dropped dramatically in the office (-52%), with a smaller absolute rate increase in the HOPD (+71%). cPET nearly tripled in the cardiology office (+193%), but rates remained steady for radiologists. Conclusion: While most cardiologist in-office imaging has shifted to the HOPD, there has been an increase in in-office cPET, likely due to a combination of technological advances, interpretation familiarity, and financial incentives. Radiologist cCTA rates continue to increase, representing a growing opportunity for radiologists to collaborate in cardiac imaging. Supplemental material is available for this article.(c) RSNA, 2021

Automated summary

The study evaluated changes in utilization of various cardiac imaging modalities over a 10-year period. There was a shift in utilization from cardiologist offices to hospital outpatient departments for most imaging modalities, except for cardiac positron emission tomography (cPET) which increased in cardiologist offices. Radiologist-performed coronary CT angiography (cCTA) rates continue to rise, providing opportunities for collaboration in cardiac imaging.