Nerve-conduction studies - and costs - down after Medicare changes, IHPI team finds

As the agency that runs Medicare works to reduce inappropriate use of certain medical services, and their resulting costs, a new study by several IHPI-affiliated neurologists shows that it may just be working in the area of nerve conduction studies, or NCS. 

In a research letter recently published in JAMA Internal Medicine, the team shows the impact of Medicare's decision to reduce the amount physicians and other providers would be reimbursed for carrying out NCS. The reduction started in January 2013, after an Office of the Inspector General for the U.S. Department of Health and Human Service report showing that NCS and other electrodiagnostic tests were prone to fraud, waste and abuse. 

For the new research, IHPI members Brian Callaghan, M.D., M.S. and his colleagues looked at Medicare records for NCS and electromyography, or EMG, before and after the reimbursement cut. 

In all, they found that NCS use dropped 15 percent from 2012 to 2013, and as a result Medicare payments for NCS dropped by $219 million. 

About half the drop in NCS costs happened because of a 30 percent reduction in use of the tests by providers other than neurologists and physiatrists - - even though they had accounted for just under a quarter of NCS costs before the reimbursement cut took effect.

In fact, 41 percent of these providers (who don't receive training in residency on appropriate NCS use) stopped performing NCS altogether in 2013.

By contrast, the change in reimbursement was also associated with 10- to 13-percent drops in NCS use by neurologists and physiatriasts, who do receive training in appropriate use of NCS. After the reimbursement change, use of EMG, which should typically be performed along with NCS, dropped by 3 percent among these providers -- less than half the drop seen in EMG use by other providers. 

"The pattern of change in use of EMG and NCS suggests findings similar to those in past studies of Medicare reimbursement with regard to reducing inappropriate, but not appropriate, testing and treatment," the authors write.