Trends in Hospital Performance on the Medicare National Outpatient Imaging Metrics: A 5-Year Longitudinal Cohort Analysis

Observational Trends in Publicly Reported Quality Measures of Hospital Outpatient Quality Reporting Program, 2013-2019

In 2011, the Centers for Medicare & Medicaid Services (CMS) implemented the Hospital Outpatient Quality Reporting Program to assess the quality of outpatient imaging efficiency (OIE). In this study, trends in hospital performance on these national hospital OIE measures a year after inception and public reporting were described. An observational trend analysis was conducted using 2013-2019 data from CMS 6 OIE measures. The trend analysis of metric scores indicates year-to-year variability in all 6 OIE variables. The reporting of these measures appears to have effectively improved the efficiency of most of the measures since the inception of the program.

Changes in Hospital Outpatient Quality Reporting Program Brain CT Efficiency Performance, 2013 to 2018

BACKGROUND AND PURPOSE

Inefficient imaging practices merit renewed attention in preparation for full implementation of the Appropriate Use Criteria Program. This study's purpose is to quantify changes in outpatient brain CT imaging efficiency from 2013 to 2018, including changes in relative efficiency by hospital category.

MATERIALS AND METHODS

Imaging efficiency data were obtained from the Medicare Hospital Compare website. Summary statistics were calculated for rates of unnecessarily combined brain and sinus CT scans from 2013 to 2018. Relative performance was compared by hospital Medicare payment structure, type of ownership, and affiliation with a radiology residency program. The predictive value of these hospital characteristics on brain CT efficiency was determined using linear regression analysis.

RESULTS

From 2013 to 2018, the mean frequency of unnecessarily combined brain and sinus CT scans decreased by 1.82% (95% confidence interval, 1.74%-1.90%). Proprietary and physician-owned hospitals exhibited a higher mean frequency of combined scans than other hospitals in 2013 (P < .001), and government-owned hospitals exhibited a lower mean frequency of combined scans than other hospitals in 2018 (P < .001). Radiology residency-affiliated hospitals exhibited no significant difference in 2013 but exhibited a higher mean frequency in 2018 (difference: 0.45%; 95% confidence interval, 0.29%-0.61%). Critical access hospital status and nonaffiliation with a radiology residency program were the strongest predictors of brain CT efficiency in the regression model.

CONCLUSION

Recent changes in hospitals' relative brain CT efficiency suggest category-specific differences in responsiveness to quality improvement efforts and may foreshadow similar trends under forthcoming initiatives.

Outpatient facility-based order variation in combined imaging

OBJECTIVE

Combined computed tomography (CT) occurs when one anatomical area is simultaneously imaged both without and with contrast, or two overlapping anatomical areas are imaged concurrently. While this has been studied in a Traditional Medicare population, it has not been studied in other populations subject to prior authorization. This study explores between-facility variation in ordering and receiving orders to render combined CT in a mixed commercial and Medicare Advantage population.

METHODS

Orders for CT abdomen (without/with contrast), CT thorax (without/with contrast), and concurrent CT brain and sinus authorized by a prior authorization company from 2013-2017, pertaining to patients with commercial or Medicare Advantage health plans from one national insurer, were extracted. Orders were issued and rendered by both hospitals and nonhospitals. The analysis was performed separately for each anatomical area in two ways: orders were grouped by ordering facility, and by designated rendering facility. For each facility, the ratio of combined to total orders was calculated, and analysis of variance was used to determine whether there were significant differences in this rate by year. The association between health plan type and combined imaging rates was assessed.

RESULTS

Combined rates [ratio±standard deviation] for abdomen, thorax, and brain/sinus were 0.306±0.246, 0.089±0.142, and 0.002±0.01 respectively when the analysis was conducted according to ordering facility, and 0.311±0.178, 0.096±0.113, and 0.001±0.006 when the analysis was conducted according to designated rendering facility. Combined CT abdomen and CT thorax rates decreased monotonically from 2013 to 2017, decreases that were significant (P < .01) regardless of whether orders were grouped by ordering or rendering facility. Combined CT abdomen and CT thorax rates significantly differed between orders pertaining to people with commercial and Medicare Advantage plans.

DISCUSSION

Variability was greater when orders were grouped by ordering facility, rather than rendering facility. Health plan type may influence whether a patient receives combined CT.