To quantify changes in private insurance payments for and utilization of abdominal/pelvic computed tomography scans (s) after 2011 changes in coding and Medicare reimbursement rates, which were designed to reduce costs stemming from misvalued procedures.
TruvenHealth Analytics MarketScan Commercial Claims and Encounters database.
We used difference‐in‐differences models to compare combined s of the abdomen/pelvis to s of the abdomen or pelvis only. Our main outcomes were inflation‐adjusted log payments per procedure, daily utilization rates, and total annual payments.
Claims data were extracted for all abdominal/pelvic s performed in 2009–2011 within noncapitated, employer‐sponsored private plans.
Adjusted payments per combined s of the abdomen/pelvis dropped by 23.8 percent ( < .0001), and their adjusted daily utilization rate accelerated by 0.36 percent ( = .034) per month after January 2011. Utilization rate of abdominal‐only or pelvic‐only s dropped by 5.0 percent ( < .0001). Total annual payments for combined s of the abdomen/pelvis decreased in 2011 despite the increased utilization.
Private insurance payments for combined s of the abdomen/pelvis declined and utilization accelerated significantly after 2011 policy changes. While growth in total annual payments was contained in 2011, it may not be sustained if 2011 utilization trends persist.
