Faculty Bibliography

PURPOSE: Prior studies have shown higher screening mammography rates for beneficiaries in capitated managed care Medicare Advantage (MA) plans compared with traditional fee-for-service Medicare. The aim of this study was to explore variation in screening mammography rates at the level of MA managed care plans. METHODS: Using the 2016 MA Healthcare Effectiveness Data and Information Set Public Use File, screening mammography rates were identified for all 385 reporting MA plans. Associations were explored with a range of plan characteristics from this file, as well as from the CMS Part C and Part D Medicare Star Ratings Data File, Medicare Advantage Plan Directory, and Medicare Monthly Enrollment by Plan File. RESULTS: Overall MA plan screening rates were high (mean, 72.6 +/- 9.4%) but varied substantially among plans (range, 14.3%-91.8%). Screening rates were higher in nonprofit versus for-profit plans (77.3% versus 71.8%, P < .001), as well as in health maintenance organization or local preferred provider organization plans versus private fee-for-service or regional preferred provider organization plans (71.9%-73.2% versus 65.5%-66.8%, P = .001). Among parent organizations with five or more plans, screening rates were highest for Kaiser Foundation (median, 88.4%) and lowest for Molina Healthcare (median, 65.3%). Screening rates showed small but significant associations with plans' contract lengths, enrolled populations, and counties served. Screening rates showed strong associations (r = 0.796-0.798) with colorectal cancer screening and annual flu vaccine rates and showed moderate associations (r = 0.283-0.365) with ambulatory and preventive care visits, osteoporosis screenings, body mass index assessments, and nonrecommended prostate-specific antigen screenings after age 70. CONCLUSIONS: Screening mammography rates vary considerably among MA plans. With increased federal interest in promoting the MA program, enhanced transparency will be necessary to ensure appropriate Medicare beneficiary participation decision making.

As societal stakeholders call for increased evidence-based health policy, considerable attention has focused on Medicare, the country's largest payer. Concurrently, medical imaging has come under considerable scrutiny as a contributor to rising health care expenditures. Accordingly, many recent studies have focused on multiple factors related to the utilization of imaging among Medicare beneficiaries. This article summarizes several national Medicare fee-for-service data sources relevant to supporting ongoing investigations. Aggregated 100% data sets include the Physician/Supplier Procedure Summary Master Files and the Medicare Provider Utilization and Payment Data: Physician and Other Supplier Public Use File. The former focuses on services, specialties, and sites of service; the latter focuses on providers. Both permit high-level national assessments of imaging utilization and spending. Individual 5% random-sample claims-level data sources include the Carrier Standard Analytical File Limited Data Set and the Research Identifiable File, which contain greater beneficiary-level information. Both facilitate more robust patient- and encounter-level analyses and some assessment of downstream outcomes but involve greater costs and require greater privacy oversight. More recently, Medicare data are being merged with registry data (eg, Surveillance, Epidemiology, and End Results-Medicare Linked Database files), creating opportunities for even more robust analyses given richer clinical information. Understanding these data sets and trade-offs in their use will aid policy-focused imaging health services researchers in most effectively conducting their investigations.

On 8 November 2016 the American electorate voted Donald Trump into the Presidency and a majority of Republicans into both houses of Congress. Since many Republicans ran for elected office on the promise to 'repeal and replace' Obamacare, this election result came with an expectation that campaign rhetoric would result in legislative action on healthcare. The American Health Care Act (AHCA) represented the Republican effort to repeal and replace the Affordable Care Act (ACA). Key elements of the AHCA included modifications of Medicaid expansion, repeal of the individual mandate, replacement of ACA subsidies with tax credits, and a broadening of the opportunity to use healthcare savings accounts. Details of the bill and the political issues which ultimately impeded its passage are discussed here.

RATIONALE AND OBJECTIVES: This study aimed to characterize recent National Institutes of Health (NIH) funding for diagnostic radiology departments at US medical schools. MATERIALS AND METHODS: This retrospective study did not use private identifiable information and thus did not constitute human subjects research. The public NIH Research Portfolio Online Reporting Tools Expenditure and Results system was used to extract information regarding 887 NIH awards in 2015 to departments of "Radiation-Diagnostic/Oncology." Internet searches were conducted to identify each primary investigator (PI)'s university web page, which was used to identify the PI's departmental affiliation, gender, degree, and academic rank. A total of 649 awards to diagnostic radiology departments, based on these web searches, were included; awards to radiation oncology departments were excluded. Characteristics were summarized descriptively. RESULTS: A total of 61 unique institutions received awards. The top five funded institutions represented 33.6% of all funding. The most common institutes administering these awards were the National Cancer Institute (29.0%) and the National Institute of Biomedical Imaging and Bioengineering (21.6%). Women received 15.9% of awards and 13.3% of funding, with average funding per award of $353,512 compared to $434,572 for men. PhDs received 77.7% of all awards, with average funding per award of $457,413 compared to $505,516 for MDs. Full professors received 51.2% of awards (average funding per award of $532,668), compared to assistant professors who received 18.4% of awards ($260,177). Average funding was $499,859 for multiple-PI awards vs. $397,932 for single-PI awards. Common spending categories included "neurosciences," "cancer," "prevention," and "aging." CONCLUSIONS: NIH funding for diagnostic radiology departments has largely been awarded to senior-ranking male PhD investigators, commonly at large major academic medical centers. Initiatives are warranted to address such disparities and promote greater diversity in NIH funding among diagnostic radiology investigators.

RATIONALE AND OBJECTIVES: This study aims to assess the impact of off-campus facility expansion by a large academic health system on patient travel times for screening mammography. MATERIALS AND METHODS: Screening mammograms performed from 2013 to 2015 and associated patient demographics were identified using the NYU Langone Medical Center Enterprise Data Warehouse. During this time, the system's number of mammography facilities increased from 6 to 19, reflecting expansion beyond Manhattan throughout the New York metropolitan region. Geocoding software was used to estimate driving times from patients' homes to imaging facilities. RESULTS: For 147,566 screening mammograms, the mean estimated patient travel time was 19.9 +/- 15.2 minutes. With facility expansion, travel times declined significantly (P < 0.001) from 26.8 +/- 18.9 to 18.5 +/- 13.3 minutes (non-Manhattan residents: from 31.4 +/- 20.3 to 18.7 +/- 13.6). This decline occurred consistently across subgroups of patient age, race, ethnicity, payer status, and rurality, leading to decreased variation in travel times between such subgroups. However, travel times to pre-expansion facilities remained stable (initial: 26.8 +/- 18.9 minutes, final: 26.7 +/- 18.6 minutes). Among women undergoing mammography before and after expansion, travel times were shorter for the postexpansion mammogram in only 6.3%, but this rate varied significantly (all P < 0.05) by certain demographic factors (higher in younger and non-Hispanic patients) and was as high as 18.2%-18.9% of patients residing in regions with the most active expansion. CONCLUSIONS: Health system mammography facility geographic expansion can improve average patient travel burden and reduce travel time variation among sociodemographic populations. Nonetheless, existing patients strongly tend to return to established facilities despite potentially shorter travel time locations, suggesting strong site loyalty. Variation in travel times likely relates to various factors other than facility proximity.

PURPOSE: To use patient-generated data to assess the changing role of emergency department (ED) imaging for a spectrum of clinical indications. METHODS: The Household Component Emergency Room Visits File was obtained from 1996 through 2014 for the Medical Expenditure Panel Survey, a nationally representative survey of US households. Percentage of visits associated with various imaging modalities was computed annually, stratified by respondents' self-reported primary condition during the visit. Modality characteristics were assessed for conditions most frequently imaged in 1996 or 2014. RESULTS: For most conditions, use of advanced imaging (defined by Medical Expenditure Panel Survey as CT or MRI) in the ED increased significantly (P < .001). The largest growth occurred for urinary calculus (from 0% to 48.5%) and headache (from 17.5% to 33.3%), which were the most commonly imaged conditions by CT or MRI in 2014. For ultrasound, the most commonly imaged condition was pregnancy in 1996 (32.9%) and 2014 (44.5%). No other condition was associated with ultrasound in >20% of visits. For radiography, the most commonly imaged conditions were extremity wounds and fractures in 1996 (range 84.5%-90.2%) and 2014 (range 93.4%-93.9%). Use of radiography decreased for urinary calculus from 67.4% to 24.2% (P < .001). CONCLUSION: For many conditions, ED utilization of advanced imaging increased significantly, though growth was variable across conditions. In certain scenarios, advanced ED imaging is adding to, rather than replacing, other modalities. Ultrasound and radiography utilization was overall unchanged. That national patient survey data mirror traditional claims-based studies suggests an expanded role for patient-generated data in identifying areas of imaging utilization that may benefit from targeted optimization efforts.

PURPOSE: To examine changes in the utilization of procedures related to treatment of chronic venous insufficiency (CVI) in the Medicare population. MATERIALS AND METHODS: Service-specific claims data for phlebectomy, sclerotherapy, and radiofrequency (RF) and laser ablation were identified by using Medicare Physician Supplier Procedure Summary master files from 2005 through 2014. Longitudinal national utilization rates were calculated by using annual Medicare enrollment data from 2005 through 2013. Procedure volumes by specialty group and site of service were analyzed. RESULTS: Total annual claims for these procedures in the Medicare fee-for-service beneficiaries increased from 95,206 to 332,244 (Compound Annual Growth Rate [CAGR], 15%) between 2005 and 2014. Per 1,000 beneficiaries, overall utilization increased annually from 2.8 in 2005 to 9.4 in 2013. Most procedures were performed in the private office setting (92% in 2014). In 2014, radiologists had a 10% relative market share, compared with vascular surgeons, other surgeons, and cardiologists, who had 26%, 25%, and 14% market shares, respectively. Cardiologists had the fastest relative growth, with a CAGR of 51% compared with 23% for radiology, 12% for vascular surgery, and 13% for other surgery. Total venous RF ablation services grew with a CAGR of 31%, with radiology and cardiology growing most rapidly (40% and 79%, respectively). Total venous laser ablation services grew with a CAGR of 22%, with radiology growing 15% and cardiology growing most rapidly at 44%. CONCLUSIONS: Utilization of CVI procedures in the Medicare population increased markedly from 2005 through 2014. The overwhelming majority are performed in the private office setting by nonradiologists.