Of all US physicians, who serves the sickest patients? Radiologists

U.S. radiologists serve more medically complex Medicare cases than most physicians, according to a study published in the February issue of Academic Radiology. Of 54 different physician specialties, three radiology practices (interventional radiology, nuclear medicine and diagnostic radiology) ranked in the top 25 of specialties who treat more medically complex patients. 

The study also emphasized the importance of strengthening physician performance and the shift from fee-for-service models to value-based payment models. Complexity of patient populations for all physician specialties must be noted to ensure the best clinical practice and patient outcomes, the researchers wrote. This is especially true for physicians caring for sicker patients in university and tertiary care centers.  

Researchers from NYU's Langone Medical Center calculated the average beneficiary Hierarchical Condition Category (HCC) risk scores for all physicians using 2014 Medicare claims data, according to study methods. Scores were then compared across all 54 physician specialties and arranged based on a variation of characteristics for final analysis.  

CMS developed the HCC risk scores to assess the risk level of groups of beneficiaries versus the overall Medicare population. Beneficiary age, gender, reason for Medicare eligibility, Medicaid eligibility status and clinically significant comorbidities determined the overall score. Higher scores indicated patients with a greater medical risk.

After using 2014 Medicare claims data from 549,194 physicians, researchers identified the mean HCC risk score was 1.62, according to study results. Of the 31,175 radiologists studied, the mean HCC risk score was 1.79. For noninterventional radiology subspecialties, cardiothoracic radiologists had the highest HCC score of 2.09 and breast imagers with the lowest HCC score of 1.08.  

Additionally, the three radiology specialties that ranked in the top 25 scored the following HCC score:  

• Interventional radiology - ranked 4th, mean HCC of 2.6. 
• Nuclear medicine - ranked 16th, mean HCC of 1.87. 
• Diagnostic radiology - ranked 21st, mean HCC of 1.75. 

Researchers also found that HCC risk scores were greater for male radiologists and radiologists working in large, urban or subspecialized practices. However, the strongest independent predictor of patient complexity was radiologists with teaching affiliations.  

Overall, researchers suggest that radiologists must be proactive in seeking more favorable risk adjustment payments arrangements to put efficient care at the forefront to expect greater resource utilization for complex medical patients.  

"Our findings raise a number of possible areas of further investigation, including exploration of the basis of variation in HCC risk scores among defined subsets of radiologists, development of methodologies for adjusting quality performance metrics based on risk scores, and determination of a patient population’s risk at the group rather than at the individual radiologist level for purposes of group-level risk-based payment models," Rosenkrantz et al. concluded.