Characteristics of COVID-19 Community Practice Declines in Non-Invasive Diagnostic Imaging Professional Work

Duszak, Richard; Maze, Jeff; Sessa, Candice; Fleishon, Howard B.; Golding, Lauren P.; Nicola, Gregory N.; Hughes, Danny R.

Purpose The operational and financial impact of the widespread COVID-19 curtailment of imaging services on radiology practices is unknown. We aimed to characterize recent COVID-19 related community practice non-invasive diagnostic imaging professional work declines. Methods Using imaging metadata from nine community radiology practices across the United States between January 2019 and May 2020, we mapped work relative value unit (wRVU) weighted stand-alone non-invasive diagnostic imaging service codes to both modality and body region. Weekly 2020 vs. 2019 wRVU changes were analyzed by modality, body region, and site of service. Practice share Chi-square testing was performed. Results Aggregate weekly wRVUs ranged from a high of 120,450 (February 2020) to a low of 55,188 (April 2020). During that -52% wRVU nadir, outpatient declines were greatest (-66%). All practices followed similar aggregate trends in the distribution of wRVUs between each 2020 vs. 2019 week (p=0.96-0.98). As a percentage of total all-practice wRVUs, declines in CT (20,046/63,992; 31%) and radiography/fluoroscopy (19,196; 30%) were greatest. By body region, declines in abdomen/pelvis (16,203; 25%) and breast (12,032; 19%) imaging were greatest. Mammography (-17%) and abdominal/pelvic CT (-14%) accounted for the largest shares of total all-practice wRVU reductions. Across modality-region groups, declines were far greatest for mammography (-92%). Conclusions Substantial COVID-19 related diagnostic imaging work declines were similar across community practices and disproportionately impacted mammography. Decline patterns could facilitate pandemic second wave planning. Overall implications for practice workflows, practice finances, patient access, and payment policy are manifold.