67th Annual Meeting Abstracts
Utilization of Helical Computer Tomograghy as a Replacement for Intravenous Urography: Cost of Progress?
Eugene V Kramolowsky, Kent L Rollins, *Nada L Wood
Virginia Urology, Richmond, VA
Introduction: Radiograhic imaging is essential to the urologist to make clinical diagnosis. Intravenous urography (IVU) has been integrated for the work up of calculi and hematuria. Advancement of computerized tomography (CT) has changed urologists’ practice patterns and impacted usage of IVU. The degree of utilization and the cost of CT scanning as the imaging modality are evaluated.
Materials & Methods: A large single-specialty urology practice database was reviewed from1/2000 to 1/2008, comparing utilization of IVU and helical CT scan imaging. Utilization of imaging modalities over time was done by annual data analysis. 2007 regional Medicare fee schedule was used to compare the facility payment of imaging per year. (IVU payment: $76.04 and CT Abdomen/Pelvis payment: $343.31)
Results: IVU utilization was consistent until 2002. Between 2002 and 2004, IVU utilization dropped from 56% of the imaging to 24% and continued to decrease. In 2000, 3905 radiology studies (CT & IVU) were ordered; 55% were IVUs. In 2007, 4292 radiology studies were ordered; only 3% were IVUs. Total number of studies (IVU and CT) ordered per year remained relatively constant over the study period. Annual total imaging cost, based on 2007 Medicare fee schedule, between 2000 and 2007 increased 48%, from $766,338 in 2000 to $1,481,851 in 2007.
Conclusions: Imaging of patients shifted from IVU to CT over the study period. Cost of imaging increased as practice patterns changed. The change in practice pattern was most likely driven by the substitution of a better modality (CT scan) for a lesser modality (IVU).
