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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.

November 14, 2017

Physician Specialty Characteristics Associated with Higher Patient Complexity

A new Harvey L. Neiman Health Policy Institute study assesses physician specialty and radiologist characteristics associated with higher patient complexity in the Medicare population. The research is published online in Academic Radiology.

The average beneficiary Hierarchical Condition Category (HCC) risk scores (Medicare’s preferred measure of clinical complexity) were identified for all physicians using publically available 2014 Medicare claims data. HCC scores were compared among physician specialties and further evaluated for radiologists based on a range of characteristics. Additionally, the researchers used the recently published radiologist subspecialty classification system called Neiman Imaging Types of Services (NITOS), to assign radiologists as generalists or subspecialists. Of 549,194 physicians across 54 specialties, the mean HCC risk score was 1.62±0.75. Interventional radiology ranked #4 of 54, nuclear medicine #16 and diagnostic radiology #21. Among all Medicare participating 31,175 radiologists, the risk scores were higher for those with teaching vs. non-teaching affiliations, larger practices, those practicing in urban (vs rural) settings, and more subspecialized (vs. generalized) practice patterns.

“Patient complexity varies considerably among physicians and overall was higher for radiologists than most other physicians,” noted senior author 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 senior affiliate research fellow at the Neiman Institute. “Among radiologists, a teaching affiliation served as the strongest independent predictor of patient complexity in our multivariable analyses.”

“To our knowledge, there is little previous work focusing on this aspect of radiologists’ practice, which may become increasingly relevant as the specialty prepares itself for future risk-bearing contracts and physician performance measure transparent initiatives.” said Andrew Rosenkrantz, MD, MPA, lead study author and a Neiman Institute affiliate research fellow. “As patient complexity is increasingly recognized as a central predictor of clinical outcomes and resource utilization, ongoing insights into patient complexity may assist radiologists in navigating emerging risk-based payment models.”

To obtain a copy of the study or to arrange an interview with a Neiman Institute spokesperson, contact Nichole Gay at (703) 648-1665 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.


Nichole Gay
Harvey L. Neiman Health Policy Institute