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The mission of the Harvey L. Neiman Health Policy Institute® is to establish foundational evidence for health policy and radiology practice that promotes the effective and efficient use of health care resources and improves patient care.

March 13, 2017

New Study Finds Medicare Imaging Utilization and Costs Vary More at County Than State Levels

Reston, VA – A new research study by the Harvey L. Neiman Health Policy Institute assesses relationships between county-level variation in Medicare beneficiary imaging resource consumption and measures of population economic status. The study, published online in the Journal of the American College of Radiology (JACR), found that in the Medicare population, imaging utilization and costs vary greatly at the county-level, and far more than at the state-level.

“Using the 2013 Centers for Medicare and Medicaid Services Geographic Variation Public Use File, we observed wide (up to 4-fold) variation in Medicare beneficiary imaging utilization and program costs at the state-level and far wider (up to 14-fold) variation at the county-level,” said  Andrew Rosenkrantz, MD, MPA, lead study author and a Neiman Institute affiliate research fellow.

Rosenkrantz and his colleagues used the County Health Rankings and Roadmaps database to identify county-level measures of population economic status. Specifically, county-level unemployment rates and rates of uninsured in those under the age of 65 within the county—both measures not anticipated to directly apply to a largely older and retiree Medicare population—were independently associated with greater imaging resource consumption in that county’s Medicare beneficiaries.

“These associations suggest that local indigenous socioeconomic factors—ones outside the scope of traditional beneficiary-focused policy activities—influence Medicare imaging use, noted Rosenkrantz, an associate professor of radiology at NYU Langone Medical Center.

“In view of our findings, policy efforts to standardize and reduce variation in imaging intensity across the country should consider the high variability existing at county-level geographic units, and focus less on national “one size fits all” approaches,” said Richard Duszak, MD, FACR, professor and vice chair for health policy and practice in the department of radiology and imaging sciences at Emory University and affiliate senior research fellow at the Harvey L. Neiman Health Policy Institute. “Future efforts to optimize Medicare imaging use should consider the influence of public health measures that are not always accounted for in policy-focused health services research.”

To obtain a copy of the JACR study or to arrange an interview with a Neiman Institute spokesperson, contact Nicole Racadag at (703) 716-7559 or


About the Harvey L. Neiman Health Policy Institute
The Harvey L. Neiman Health Policy Institute is one of the nation’s leading medical imaging socioeconomic research organizations. The Neiman Institute studies the role and value of radiology and radiologists in evolving health care delivery and payment systems and the impact of medical imaging on the cost, quality, safety and efficiency of health care. Visit us at and follow us on TwitterLinkedIn and Facebook.


Nicole Racadag
Harvey L. Neiman Health Policy Institute
(703) 716-7559