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Biomedical subjects

D C Levin

Publications and source records attributed to D C Levin.

At least 37 records · Page 2Linked to original sources
PubMed1998

Impact of MR imaging on nationwide health care costs and comparison with other imaging procedures.

OBJECTIVE: We wished to determine the extent to which MR imaging contributes to the overall costs of imaging in the United States and to compare MR imaging costs with other imaging techniques. MATERIALS AND METHODS: All 23 current procedural terminology, version 4 (CPT-4) codes for MR imaging were extracted from the national 1993 Part B Medicare annual data reimbursement file. For each code, we calculated total Medicare physician reimbursements. Aggregate reimbursement for all MR imaging was compared with aggregate reimbursement for all 659 imaging-related current procedural terminology, version 4 codes and also with comparable figures for echocardiography and other categories of cardiovascular imaging. RESULTS: Within the 23 MR imaging codes, 1,449,911 examinations were performed on Medicare patients in 1993, for which physicians were reimbursed $370 million. Medicare reimbursement of physicians for all 659 imaging-related procedures was $5.3 billion. Thus, MR imaging accounted for only 7% of all imaging costs. By comparison, a group of just 10 imaging codes, which are primarily cardiovascular in nature, accounted for $1.67 billion, or 32% of the entire Part B costs for imaging. Reimbursements for echocardiography alone are more than twice those for MR imaging. CONCLUSION: From the national perspective, MR imaging does not appear to warrant its reputation as a costly procedure. The costs of echocardiography and other imaging related to the cardiovascular system are considerably higher.

Diagnostic Imaging↗
PubMed1998

Practice patterns of radiologists and nonradiologists: nationwide Medicare data on the performance of chest and skeletal radiography and abdominal and pelvic sonography.

OBJECTIVE: We assessed the relative roles of radiologists and nonradiologists in performing chest and skeletal radiography and nonobstetric abdominal and pelvic sonography. MATERIALS AND METHODS: Information was extracted from the 1993 Medicare file on procedure volume for 65 imaging procedures. Claims were categorized by the specialty of the physician and the location (office or hospital) where the service was performed. RESULTS: In hospitals, radiologists performed virtually all chest and skeletal radiography and nonobstetric abdominal and pelvic sonography. In nonhospital settings such as offices or imaging centers, nonradiologists performed approximately two thirds of the chest and spinal radiography and nonobstetric abdominal and pelvic sonography and larger percentages (78-86%) of the pelvic, hip, lower extremity, and upper extremity radiography. CONCLUSION: Although radiologists perform virtually all chest and skeletal radiographs and abdominal and pelvic sonograms obtained in hospitals, they perform a distinct minority of these procedures in nonhospital settings. The data we present have certain implications for the amount of training nonradiologists receive in diagnostic imaging.

Bone and Bones↗
PubMed1997

Who performs neuroimaging? Results from the 1993 National Medicare Database.

PURPOSE: To determine the level of participation of nonradiologists in computed tomography (CT) and magnetic resonance (MR) imaging of the brain, head and neck, and spine at hospitals and at private offices and imaging centers in the United States. MATERIALS AND METHODS: The 1993 Part B Medicare Annual Database was used to determine the number of procedures performed by radiologists and nonradiologists at hospitals and at private offices or imaging centers. The fourth edition of the Physicians' Current Procedural Terminology was used to classify procedures. RESULTS: Of the 3,883,391 neurologic CT and MR imaging studies billed to Medicare in 1993, 3,148,088 (81%) were obtained in a hospital setting; only 58,005 (2%) of these studies were interpreted by nonradiologists. Of the 735,303 imaging studies (19%) obtained at a private office or imaging center, only 63,115 (9%) studies were interpreted by nonradiologists. Overall, nonradiologists performed only 121,120 (3%) of the neuroimaging examinations billed to Medicare nationwide in 1993. CONCLUSION: The level of participation of nonradiologists in the interpretation of results from neurologic CT and MR imaging billed to Medicare is minimal.

Central Nervous System Diseases↗
PubMed1996

Addition of anticholinergic solution prolongs bronchodilator effect of beta 2 agonists in patients with chronic obstructive pulmonary disease.

A randomized, double-blind placebo-controlled clinical trial was designed to assess the safety, efficacy, and duration of the bronchodilation resulting from the addition of 500 micrograms of ipratropium bromide (Atrovent; Boehringer Ingelheim, CT) inhalation solution to standard small volume nebulizer treatments with 2.5 mg albuterol inhalation solution. A total of 195 patients (63% men, average age 64 years) with > 10 pack-year smoking histories and stable, moderate-to- severe chronic obstructive pulmonary disease (COPD; forced expiratory volume in 1 second [FEV1] 1.02 liter, 38.8% predicted) from eight university-affiliated chest clinics in seven U.S. cities were enrolled into the study. Asthma, rhinitis, and eosinophilia were exclusions, as was daily use of > 10 mg of prednisone (or 20 mg on alternate days). There was a 2-week stabilization period during which the patients were instructed in the use of the small volume nebulizers, which they used three times daily with albuterol alone. They were asked to keep daily logs of peak flow rates, pulmonary symptoms, and additional medication usage. On their test day 1 the subjects came to the pulmonary function laboratory having been off theophylline for 24 hours and beta 2-agonists for 12 hours and performed a baseline spirometry. They then received their morning small volume nebulizer treatment of albuterol to which was added either 500 micrograms if ipratropium bromide or a saline placebo. Spirometry was repeated at 15, 30, and 60 minutes, and then hourly for 8 hours. Subjects then took home a 2-week supply of albuterol and test drug for thrice daily use in their small volume nebulizer. They were evaluated for pulmonary symptoms and adverse effects every 14 days. The 8-hour spirometry was repeated on test day 43 and finally on test day 85. Primary data evaluated were the peak increase in FEV1 and the area between the FEV1 baseline value and the 8-hour FEV1 curve. Similar calculations were made for forced vital capacity (FVC) and 25-75% forced expiratory flow (FEF25-75%). On test day 1 the peak increase in FEV1 for the ipratropium bromide + albuterol subjects was 26% greater than those on placebo + albuterol (p < 0.003). The area under the 8-hour FEV1 curve was 64% greater in those given ipratropium bromide on test day 1 (p < 0.0002). Similar increases were seen in FVC and FEF25-75%. The peak improvements in FEV1 and FVC with the addition of ipratropium bromide to albuterol were maintained on test days 43 and 85. Considering the safety and efficacy profiles of this combination, the data would suggest that ipratropium bromide inhalation solution should be considered first-line therapy for those patients with COPD requiring small volume nebulizer treatments.

Administration, Intranasal↗
PubMed1996

Capitated contracting in radiology: negotiating techniques, financial calculations, and utilization management.

The authors describe how to develop and manage a capitated outpatient radiology contract. Aspects of a capitated fee structure and the need to apportion fees between a hospital and its radiology group are discussed. During negotiations with a managed care organization (MCO), certain information and commitments should be obtained. Utilization data should also be obtained from the MCO, but if they are not available (or are thought to be unreliable), certain norms can be used. Once a utilization projection is arrived at, reimbursement calculations can be made and compared with assumed reimbursements under a known fee schedule, such as that of Medicare. This procedure allows one to estimate whether a capitated proposal is financially feasible. Once a contractual agreement is instituted, the radiology group must then track and manage utilization. An understanding of these principles should enable radiologists to deal effectively with both practice and fiscal concerns presented by managed care.

Adult↗
PubMed1995

Trends in use of barium enema examination, colonoscopy, and sigmoidoscopy: is use commensurate with risk of disease?

PURPOSE: To assess replacement of barium enema examination with colonoscopy in relation to age- and sex-related risk factors, place of service, physician specialty, and cost. MATERIALS AND METHODS: Between 1985 and 1992, 894,777 insurance claims for barium enema examination and lower gastrointestinal endoscopy were retrospectively examined. Changes in use were investigated. Use of proctosigmoidoscopy and flexible sigmoidoscopy, two office-based endoscopic procedures, was also examined. RESULTS: Use of diagnostic colonoscopy increased from 191 to 406 services per 100,000 persons; colonoscopy with biopsy, from 77 to 183 services; and colonoscopy with lesion removal, from 77 to 202 services. Barium enema examination use declined from 929 to 511 services per 100,000 persons; diagnostic proctosigmoidoscopy, from 854 to 193 services; and diagnostic flexible sigmoidoscopy, from 656 to 620 services. Increases in use of colonoscopy in patients aged younger than 40 years were greater than overall increases. CONCLUSION: Colonoscopy has been replacing barium enema examination as the initial colorectal examination since 1985. Increased use of colonoscopy in patients with lower risk of neoplasia suggests that indications have become overly broad.

Adult↗
PubMed1995

Participation by radiologists and other specialists in percutaneous vascular and nonvascular interventions: findings from a seven-state database.

PURPOSE: To determine the relative degree of participation by radiologists and other specialists in percutaneous interventional procedures. MATERIALS AND METHODS: By using 1992 Medicare Part B claims data that covered seven states, the specialty of the physician provider was determined for all services performed within various percutaneous vascular and nonvascular interventional procedure codes. RESULTS: Radiologists' performance of interventional procedures in descending percentage of participation was as follows: renal cyst aspiration (92.7%), biliary decompression (90.5%), abdominal or retroperitoneal mass biopsy (87.7%), lung or mediastinal biopsy (84.2%), noncardiac angioplasty (76.8%), pancreatic biopsy (75.2%), upper urinary tract decompression (73.7%), liver biopsy (43.7%), renal biopsy (38.4%), certain types of abscess drainages (38.2%), and thoracentesis with tube insertion (29.4%). They had only small roles in thoracentesis for aspiration (4.7%) and tube thoracostomy (1.7%). CONCLUSION: Despite controversy between radiologists and other specialists over who should perform percutaneous interventions, radiologists have maintained strong predominance in many types of these procedures. In others, they have a shared, but still major, role.

Angioplasty, Balloon↗
PubMed1994

Merrill C. Sosman Lecture. The practice of radiology by nonradiologists: cost, quality, and utilization issues.

Although some things have not changed much since Merrill Sosman's time, many ethical and economic aspects of medical practice are now being scrutinized much more closely than in the past. Among the questions being asked are the following: Are physicians overutilizing technology? How much and by what criteria are physicians being paid (or overpaid)? Is the best possible quality of care being provided to patients? During the past few years, several colleagues and I have worked with a group at Pennsylvania Blue Shield (PBS) to study utilization, cost, and quality issues associated with the practice of radiology by nonradiologists. Compelling data and concepts have emerged from these studies. This article reviews some of our findings and other issues in three areas: (1) utilization patterns and costs for outpatient radiographic, sonographic, CT, and MR imaging examinations of PBS subscribers throughout the state during 1991; (2) recent trends in the utilization of barium enemas, colonoscopy, and percutaneous transluminal coronary angioplasty (PTCA); and (3) comparison of the quality of radiographic examinations performed by radiologists and nonradiologists. Although these subjects are somewhat disparate, they all bear on the three health policy questions posed above. They also relate to the landmark studies of Hillman et al. [1, 2], who demonstrated that self-referring nonradiologist physicians who perform their own radiographic and sonographic studies perform two to eight times as many of these studies as do other physicians who instead refer their patients to radiologists.

Angioplasty, Balloon, Coronary↗