Publications

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)

Patient Cost-Sharing and Utilization of Breast Cancer Diagnostic Imaging by Patients Undergoing Subsequent Testing After a Screening Mammogram

Out-of-pocket costs (OOPCs) have been largely eliminated for screening mammography. However, patients still face OOPCs when undergoing subsequent diagnostic tests after the initial screening, which represents a potential barrier to those who require follow-up testing after initial testing. This study examines the association between the degree of patient cost-sharing and the use of diagnostic breast cancer imaging after undergoing a screening mammogram. Full Article

Danny R. Hughes, PhD; William Espinoza, MS; Sarah Fein, MS; Elizabeth Y. Rula, PhD; Geraldine McGinty, MD, MBA. 2023. "Patient Cost-Sharing and Utilization of Breast Cancer Diagnostic Imaging by Patients Undergoing Subsequent Testing After a Screening Mammogram," JAMA Network Open

Urbanicity, Income, and Mammography-Use Disparities Among American Indian Women

Reported breast cancer screening among American Indian women is consistently below that of White women. The last claims-based trends were from 1991 to 2001. This study updates mammography trends for American Indian women and examines the impact of race, urbanicity, and income on long-term mammography use. Full Article

Eric W. Christensen, PhD Casey E. Pelzl, MPH Bhavika K. Patel, MD Ruth C. Carlos, MD, MS Elizabeth Y. Rula, PhD. 2023. "Urbanicity, Income, and Mammography-Use Disparities Among American Indian Women," American Journal of Preventive Medicine, 64(5)

The No Surprises Act: What Neuroradiologists Should Know

The No Surprises Act (NSA) is the first federal law to address surprise medical billing and became effective as of January 2022. This law prohibits balance billing to patients who receive unexpected out-of-network care and limits patient payments to their in-network cost-sharing (coinsurance, copay, or deductible). Many neuroradiologists and neurointerventionalists are involved in care that may be subject to the NSA, such as stroke or trauma work-ups from the emergency department, and, thus, should be aware of the implications. Full Article

T.H. Nguyen, R.E. Heller, K. Keysor, J.M. Milburn, E.Y. Rula, R. Spangler, and J.A. Hirsch. 2022. "The No Surprises Act: What Neuroradiologists Should Know," American Journal of Neuroradiology

Association of State Share of Nonphysician Practitioners With Diagnostic Imaging Ordering Among Emergency Department Visits for Medicare Beneficiaries

The objective of this study was to investigate whether the state share of ED visits for which an NPP was the clinician of record is associated with imaging studies ordered, given that state NPP share is associated with state-level NPP scopes of practice. Full Article

Eric W. Christensen, PhD; Chi-Mei Liu, PhD; Richard Duszak Jr, MD; Joshua A. Hirsch, MD; Timothy L. Swan, MD; Elizabeth Y. Rula, PhD. 2022. "Association of State Share of Nonphysician Practitioners With Diagnostic Imaging Ordering Among Emergency Department Visits for Medicare Beneficiaries," JAMA Network Open

Drivers of Ischemic Stroke Hospital Cost Trends Among Older Adults in the United States

The researchers objective was to examine the association of treatment and neuroimaging with ischemic stroke total hospital cost growth for the Medicare fee-for-service population. Full Article

Eric W. Christensen, PhD , Casey E. Pelzl, MPH, Jennifer Hemingway, MS, Jason J. Wang, PhD, Maria X. Sanmartin, PhD, Jason J. Naidich, MD, MBA, Elizabeth Y. Rula, PhD, Pina C. Sanelli, MD, MPH. 2022. "Drivers of Ischemic Stroke Hospital Cost Trends Among Older Adults in the United States," Journal of American College of Radiology (JACR)

Relationship between Race and Access to Newer Mammographic Technology in Women with Medicare Insurance

This study in Radiology examines the relationship between use of newer mammographic technology and race in women receiving mammography services. This was a multiyear (January 2005 to December 2020) retrospective study of women aged 40–89 years with Medicare fee-for-service insurance who underwent mammography. Full Article

Eric W. Christensen, Mikki Waid, Jinel Scott, Bhavika K. Patel, Jacqueline A. Bello, Elizabeth Y. Rula. 2022. "Relationship between Race and Access to Newer Mammographic Technology in Women with Medicare Insurance," Radiology