Noncardiac Point-of-Care Ultrasound by Nonradiologist Physicians: How Widespread Is It?

Abstract

The use of point-of-care (POC) ultrasound by nonradiologist physicians has recently been advocated. The aim of this study was to see how widespread this practice is. The Medicare Part B databases for 2004 to 2009 were used. Global and professional component claims for noncardiac ultrasound were tabulated, and utilization rates per 1,000 beneficiaries were calculated. Provider specialty was determined. Utilization rates of ultrasound by radiologists and other specialists were compared, and changes over the years were studied. In 2009, 425.3 Medicare noncardiac ultrasound examinations per 1,000 beneficiaries were performed (+21% since 2004). Of these, radiologists performed 233.7 (55%), and another 15.6 (4%) were done at independent diagnostic testing facilities, for which provider specialty could not be determined. The remaining 175.7 (41%) constituted POC ultrasound by nonradiologists. Between 2004 and 2009, radiologists' utilization rate increased by 17%, compared with 28% for nonradiologists. Radiologists' market share of noncardiac ultrasound was 56.6% in 2004 and 54.9% in 2009. Other major specialties involved in POC ultrasound and their 2009 rates per 1,000 and percentage increases since 2004 were cardiology (39.7 [+60%]), vascular surgery (34.9 [+36%]), primary care (27.2 [+11%]), general surgery (24.2 [+8%]), and urology (22.3 [+12%]). Between 2004 and 2009, there was a 21% increase in the overall utilization rate of noncardiac ultrasound. Point-of-care ultrasound by nonradiologists amounted to 41% of all studies done in 2009. Multiple nonradiologic specialties are involved, but radiologists' involvement is far higher than any other single specialty. Radiologists' ultrasound market share remained relatively stable between 2004 and 2009.