Publications

The Neiman Imaging Comorbidity Index: Development and Validation in a National Commercial Claims Database

To build the Neiman Imaging Comorbidity Index (NICI), based on variables available in claims datasets, which provides good discrimination of an individual’s chance of receiving advanced imaging (CT, MR, PET), and thus, utility as a control variable in research. Full Article

Casey E. Pelzl, MPH Andrew B. Rosenkrantz, MD Elizabeth Y. Rula, PhD Eric W. Christensen, PhD. 2024. "The Neiman Imaging Comorbidity Index: Development and Validation in a National Commercial Claims Database," Journal of American College of Radiology (JACR)

Radiologists’ Out-of-Network Billing Trends, 2007 to 2021

Given the financial hardships of surprise billing for patients, the aim of this study was to assess the degree to which radiologists effectively participate in commercial insurance networks by examining the trend in the share of radiologists’ imaging claims that are out of network (OON). Full Article

Jay R. Parikh, MD, Alexandra R. Drake, MPH, Mikki D. Waid, PhD, Elizabeth Y. Rula, PhD, Eric W. Christensen, PhD. 2024. "Radiologists’ Out-of-Network Billing Trends, 2007 to 2021," Journal of American College of Radiology (JACR)

Financial Viability of the No Surprises Act Independent Dispute Resolution Process: Radiology and Other Hospital-Based Specialties

The federal No Surprises Act (NSA), designed to eliminate surprise medical billing for out-of-network (OON) care for circumstances beyond patients' control, established the independent dispute resolution (IDR) process to settle clinician-payer payment disputes for OON care. The objective of this study is to assess the fraction of OON claims for which radiologists and other hospital-based specialists can expect to at least break even when challenging payer-determined payments through the NSA IDR process, as a measure of the process's financial viability. Full Article

Eric W. Christensen, PhD, Mikki D. Waid, PhD, Joshua A. Hirsch, MD, Jay R. Parikh, MD, Ali S. Raja, MD, DBA, James P. Rathmell, MD, MBA, and Elizabeth Y. Rula, PhD. 2024. "Financial Viability of the No Surprises Act Independent Dispute Resolution Process: Radiology and Other Hospital-Based Specialties," American Journal of Roentgenology

Projected Growth in FDA-Approved Artificial Intelligence Products Given Venture Capital Funding

Medical imaging accounts for 85% of digital health’s venture capital funding. As funding grows, it is expected that artificial intelligence (AI) products will increase commensurately. The study’s objective is to project the number of new AI products given the statistical association between historical funding and FDA-approved AI products. Full Article

Nicole K. McNabb, BS Eric W. Christensen, PhD Elizabeth Y. Rula, PhD Laura Coombs, PhD Keith Dreyer, DO, PhD Christoph Wald, MD Christopher Treml, MS. 2023. "Projected Growth in FDA-Approved Artificial Intelligence Products Given Venture Capital Funding," Journal of American College of Radiology (JACR)

Budget Neutrality and Medicare Physician Fee Schedule Reimbursement Trends for Radiologists, 2005 to 2021

The Medicare program, by law, must remain budget neutral. Increases in volume or relative value units (RVUs) for individual services necessitate declines in either the conversion factor or assigned RVUs for other services for budget neutrality. This study aimed to assess the contribution of budget neutrality on reimbursement trends per Medicare fee-for-service beneficiary for services provided by radiologists. Full Article

Eric W. Christensen, PhD Gregory N. Nicola, MD Elizabeth Y. Rula, PhD Lauren P. Nicola, MD Jennifer Hemingway, MS Joshua A. Hirsch, MD. 2023. "Budget Neutrality and Medicare Physician Fee Schedule Reimbursement Trends for Radiologists, 2005 to 2021," Journal of American College of Radiology (JACR)

Overall Lung Cancer Screening Rates Low

A recent study found overall estimated screening rates of 1.75% for people covered by commercial insurance, 3.37% for those covered by traditional Medicare (fee-for-service), and 4.56% for those covered by Medicare Advantage plans. Full Article

Mary Beth Nierengarten, Elizabeth Rula, PhD. 2023. "Overall Lung Cancer Screening Rates Low," Cancer

Sociodemographic Factors and Screening CT Colonography Use Among Medicare Beneficiaries

Approximately one-third of the eligible U.S. population have not undergone guideline-compliant colorectal cancer screening. Guidelines recognize various screening strategies, to increase adherence. CMS provides coverage for all recommended screening tests except for CT colonography. The objective of this study is to compare CTC and other CRC screening tests in terms of associations of utilization with income, race and ethnicity, and urbanicity, in Medicare fee-for-service beneficiaries. Full Article

Eric W. Christensen, PhD, Pina C. Sanelli, MD, MPH, Elizabeth Y. Rula, PhD, Kevin J. Chang, MD, Courtney C. Moreno, MD, David H. Bruining, MD, and Judy Yee, MD. 2023. "Sociodemographic Factors and Screening CT Colonography Use Among Medicare Beneficiaries," American Journal of Roentgenology

Trends in Diagnostic Imaging by Nonphysician Practitioners and Associations With Urbanicity and Scope-of-Practice Authority

We aimed to assess the changing share of diagnostic imaging billed by NPPs and how such changes differ by urbanicity within the context of scope-of-practice regulations and legislation. Full Article

Casey E. Pelzl MPH, Elizabeth Y. Rula PhD, Richard Duszak Jr MD, Eric W. Christensen PhD. 2023. "Trends in Diagnostic Imaging by Nonphysician Practitioners and Associations With Urbanicity and Scope-of-Practice Authority," Current Problems in Diagnostic Radiology

Imaging Utilization Patterns in the Follow-Up of Extremity Soft Tissue Sarcomas in the United States

This study aimed to describe patterns of imaging utilization after resection of extremity soft tissue sarcoma in the United States, assess for potential disparities, and evaluate temporal trends. A retrospective cohort study using a national database of private payer claims data was performed to determine the utilization rate of extremity and chest imaging in a 5-year postoperative follow-up period for patients with extremity soft tissue sarcoma treated between 2007 and 2019. Imaging utilization was assessed according to patient demographics (age, sex, race and ethnicity, and region of residency), calendar year of surgery, and postoperative year. Full Article

Natalia Gorelik MD, MPH, Elizabeth Y. Rula PhD, Casey E. Pelzl MPH, Jennifer Hemingway MSc, Eric W. Christensen PhD, James M. Brophy Meng, MD, PhD, Soterios Gyftopoulos MD, MBA, MSc. 2023. "Imaging Utilization Patterns in the Follow-Up of Extremity Soft Tissue Sarcomas in the United States," Current Problems in Diagnostic Radiology

Comparison of Lung Cancer Screening Eligibility and Use between Commercial, Medicare, and Medicare Advantage Enrollees

Lung cancer screening does not require patient cost-sharing for insured people in the U.S. Little is known about whether other factors associated with patient selection into different insurance plans affect screening rates. We examined screening rates for enrollees in commercial, Medicare Fee-for-Service (FFS), and Medicare Advantage plans. Considerable variation exists in lung cancer screening between different payers and across patient characteristics. Efforts targeting historically vulnerable populations could present opportunities to increase screening. Full Article

Danny R. Hughes, PhD; Jie Chen, PhD; Alexandra E. Wallace, MS; Shubhsri Rajendra, MS; Stefan Santavicca, MS; Richard Duszak Jr., MD; Elizabeth Y. Rula, PhD; Robert A. Smith, PhD. 2023. "Comparison of Lung Cancer Screening Eligibility and Use between Commercial, Medicare, and Medicare Advantage Enrollees," Journal of American College of Radiology (JACR), 20(4)