High-cost imaging for managed care Medicare beneficiaries with cancer, 2001-2006.

Abstract

6014 Background: Medicare expenditures are being driven upward by a rapid increase in advanced imaging in fee-for-service Medicare (FFSM) environments as part of the diagnosis and treatment of Medicare beneficiaries with cancer. Imaging rates for Medicare beneficiaries enrolled in managed care plans (MCM), where incentives may differ, are unknown. Comparing utilization in FFSM vs MCM is the first step toward comparative effectiveness evaluations of cancer imaging across economic and care models. Methods: Imaging procedures were identified for incident diagnoses of breast, colorectal (CRC), lung, prostate, leukemia, and non-Hodgkin lymphoma (NHL) cancers from 2001-2006 from 3 large managed care organizations in Washington state, Oregon, and Colorado using ICD-9-CM, CPT and HCPCS codes, consistent with methods detailed in Dinan MA, JAMA, 2010. Imaging procedures included, among others: CT scan, MRI, PET scan, and nuclear medicine studies. Two-year overall and cancer-specific mean imaging counts per MCM were calculated and compared to the previously published rates for FFSM. Results: There were 4,370 incident cancer cases, median age 79 years (interquartile range 74-83), 48% male. 41,812 total imaging procedures were performed, 25% among lung cancer patients. The mean number of images per MCM for two years of follow-up across all cancer types rose from 7.4 in 2001 to 12.9 in 2006. In 2001, rates were lower in MCM than in FFSM for all imaging modalities, including PET scans, across all cancers. By 2006 imaging rates remained lower in MCM than FFSM for the majority of modalities; exceptions included the mean number of CT scans for leukemia (4.4 vs 3.1, MCM versus FFSM respectively), NHL (7.9 vs 6.3), CRC (5.2 vs 4.8) and prostate cancer (2.5 vs 2.1). MCM rates were also higher than FFSM for nuclear medicine (1.3 vs 1.0) and PET scanning (1.3 vs 1.1) for NHL and higher for MRI for leukemia (0.6 vs 0.5). Conclusions: Overall rates of imaging are increasing for Medicare beneficiaries in managed care environments more slowly than in fee-for-service, but with greater emphasis on CT scanning and fewer PET scans on average. Future analyses will compare costs and outcomes in FFSM vs MCM, and differences in scanning rates by age (over vs under 65) in MCM.