Use of Medical Imaging
The measures on the use of medical imaging show how often a hospital provides specific imaging tests for Medicare beneficiaries under circumstances where they may not be medically appropriate. Lower percentages suggest more efficient use of medical imaging. The measures apply only to Medicare beneficiaries enrolled in Original Medicare who were treated as outpatients in hospital facilities reimbursed through the Outpatient Prospective Payment System (OPPS). These measures do not include Medicare managed care patients, non-Medicare patients, or patients who were admitted to the hospital as inpatients. Six Outpatient Imaging Efficiency measures are publicly reported.:
- MRI Lumbar Spine for Low Back Pain
- Mammography Follow-up Rates
- Abdomen Computed Tomography - Use of Contrast Material
- Thorax CT - Use of Contrast Material
- Outpatients who got cardiac imaging stress tests before low-risk outpatient surgery
- Outpatients with brain CT scans who got a sinus CT scan at the same time
Medicare Spending Per Beneficiary
The Medicare Spending Per Beneficiary (MSPB) Measure assesses all Medicare Part A and Part B payments for services provided to a Medicare beneficiary by any provider during a spending-per-beneficiary episode that spans from three days prior to an inpatient hospital admission through 30 days after discharge. The payments included in this measure are price-standardized and risk-adjusted. Price standardization removes sources of variation that are due to geographic payment differences such as wage index and geographic practice cost differences, as well as indirect medical education (IME) or disproportionate share hospital (DSH) payments. Risk adjustment accounts for variation due to patient health status.