‘Concerning finding’: Rheumatologists lack time for billing musculoskeletal ultrasound
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Key takeaways:
- The top reasons were not having time for documentation and poor reimbursement.
- Future studies should examine insurance data, as well as evaluate how ultrasound mitigates the cost of more expensive imaging.
Although most rheumatologists trained in musculoskeletal ultrasound bill for their imaging work, a “concerning” number fail to do so due to time constraints and poor reimbursement, according to data published in Arthritis Care & Research.
“Little is known about how rheumatologists are using musculoskeletal ultrasound in practice,” Fawad Aslam, MBBS, MS, a rheumatologist with the Mayo Clinic in Phoenix, Arizona, told Healio. “We know it is now a major part of most fellowships, while courses offering musculoskeletal ultrasound have increased significantly, and there is certification (RhMSUS) offered by the American College of Rheumatology, yet the specifics of practical everyday usage of musculoskeletal ultrasound by rheumatologists remain unknown.”
To examine how musculoskeletal ultrasound is used in rheumatology practices across the United States, Aslam and colleagues surveyed rheumatologists who underwent the Ultrasound School of North American Rheumatologists (USSONAR) training program.
“USSONAR has been at the forefront of training rheumatologists in musculoskeletal ultrasound for more than a decade, and as a single organization, is responsible for producing the majority of musculoskeletal ultrasound-trained rheumatologists,” Aslam said. “Surveying the past participants of the USSONAR programs seemed a practical way to gather this information.”
In September 2022, the researchers distributed the survey to 374 participants who completed the USSONAR program between 2009 and 2020. They received 105 responses, representing a response rate of 28.1%. The survey required approximately 10 minutes to complete and consisted of 28 questions regarding how respondents used musculoskeletal ultrasound and billed for it, as well as barriers to its use.
Overall, 71% of respondents were certified in musculoskeletal ultrasound, and most reported currently performing or interpreting it for diagnostic (86.7%) or procedural (81%) studies. More than three-quarters (78%) reported the USSONAR training made them better rheumatologists.
However, the survey surprised the researchers with “the significant amount of ultrasound studies that were not being billed for, and thus revenue was being lost,” Aslam said. According to the researchers, only 59.8% of respondents reported billing at least half their diagnostic studies, and 78.8% billed at least half their procedural studies.
The top reasons for lack of billing were not having enough time for documentation (44.4% in procedural and 43.2% in diagnostic) and poor reimbursement for effort (38.9% in procedural and 35.1% in diagnostic).
“In a time when ultrasound reimbursement is already declining, this is a concerning finding and may make it difficult for practices to support having a musculoskeletal ultrasound component,” Aslam said.
Aslam suggested that future studies should investigate national insurance claims data for an even broader view, as well as evaluate how well ultrasound mitigates the cost of MRI and more expensive imaging for certain situations, such as synovitis assessment. The lack of billing should also be further probed and addressed “systematically and through advocacy,” he said.
“The rheumatology ultrasound community needs more data and support to continue to advocate for better musculoskeletal ultrasound reimbursement and to argue for rheumatology-based, rather than solely relying on radiology-driven, ultrasound billing codes,” Aslam added.
For more information:
Fawad Aslam, MBBS, MS, can be reached at aslam.fawad@mayo.edu.
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