Recent Trends in Imaging for Suspected Coronary Artery Disease: What Is the Best Approach?

PURPOSE The aim of this study was to ascertain recent trends in noninvasive imaging utilization for suspected coronary artery disease. METHODS The Medicare Part B databases for 2001 to 2013 were reviewed. Current Procedural Terminology primary codes for radionuclide myocardial perfusion imaging (MPI), stress echocardiography (SE), and coronary CT angiography (CCTA) were selected. Physician specialty codes were used to designate providers as radiologists, cardiologists, and all others as a group. Procedure volumes were tabulated, and utilization rates per 1,000 Medicare beneficiaries were calculated over the period of study. RESULTS Total MPI utilization rates per 1,000 rose rapidly from 63.4 in 2001 to a peak of 88.0 in 2006 but declined every year thereafter, dropping to 61.9 in 2013. SE rates generally held steady around 12 to 13 from 2001 to 2010 but then began to decline, reaching 10.8 in 2013. Cardiologists predominate in both MPI and SE. CCTA rates were far lower. They peaked at 2.1 in 2007, but then dropped before leveling off at 1.07 in both 2012 and 2013. Radiologists and cardiologists have approximately equal roles in this procedure. CONCLUSIONS Both MPI and SE seem to be declining in use in recent years. This is likely due to unfavorable reimbursement trends caused by code bundling and resulting in the closure of many private cardiology offices. CCTA use is far lower than the two other types of imaging and has also declined in recent years. This is puzzling, as it is a new and promising procedure that has some advantages over MPI and SE. In 2013, 58 times as many MPI studies as CCTA studies were performed.