Abstract No. 166 Billing and Utilization Trends in Interventional Radiology

Within the past decade, Medicare reimbursements for interventional radiology (IR) procedures have been declining. In order to offset expenses, hospitals may increase charges. This study aimed to characterize the utilization and billing trends in IR. The 2016-2020 Provider Utilization and Payment Data Physician and Other Practitioners Dataset was queried for 18 common IR procedures. Procedure counts, hospital charges, and reimbursements were collected. The weighted mean reimbursements, charges, and charge-to-reimbursement (markup) ratios (CRR) were calculated. Total procedural utilization decreased by 9.7% from 2016 to 2020 (Table 166.1). The mean charges and reimbursements decreased by -6.8% and -22.5%, respectively. The average CRRs for all procedures increased by 20.0%. Nontunneled central venous line placement had the largest total percentage increase in CRR (49.1%). Vascular embolization for tumor/organ ischemia experienced the greatest increase in charge (27.6%). Reimbursements declined for 18 of the 19 procedures. Vascular embolization for tumor/organ ischemia had the sole increase in reimbursement (40.4%). 9 of the 18 procedures showed both an increase in charges and a decline in reimbursements. This study's analysis of IR procedures billed to Medicare Part B from 2016 to 2020 showed potentially harmful billing trends. The reimbursement rates for IR procedures declined over the study period. When looking at individual operations, half of all studied procedures experienced decreases in reimbursements along with increases in charges. If reimbursements continue to decline, we may observe charge increases in a greater number of IR procedures in an effort to offset revenue losses and expenses. This necessitates continued monitoring of billing trends in IR, as these charge increases can disproportionately affect uninsured/underinsured patients by acting as an additional barrier to care.