Financial Implications of Revised ACR Guidelines for Estimated Glomerular Filtration Rate Testing Before Contrast-Enhanced MRI

Abstract

Purpose: To quantify the financial implications of eliminating the need for renal function screening before contrast-enhanced MRI.

Methods: A HIPAA-complaint, institutional review board-exempt retrospective analysis was conducted of all MRI examinations performed at our quaternary care center over a 12-month period (41,336 examinations; 28,970 with contrast). Examination volume-related data, labor costs, and material costs were assessed and applied to a base case model. Univariate sensitivity analyses were conducted to evaluate the impact of individual components on total cost. Bivariate and multivariate sensitivity analyses were then performed. Medicare data were utilized for reimbursement and net cost analysis.

Results: The annual base case cost estimate for point-of-care estimated glomerular filtration rate testing before contrast-enhanced MRI was $126,058. Assuming 100% Medicare reimbursement for point-of-care testing, the net departmental cost was still $78,330. In univariate sensitivity analyses, MRI technologist time and i-Stat cartridge (Abbott Laboratories, Lake Bluff, Illinois) pricing were the biggest cost drivers for labor and materials costs, respectively. In multivariate sensitivity analyses, the lowest cost estimate was $6,845 and the highest cost estimate was $787,257.

Conclusion: Recent changes to screening guidelines for group II gadolinium-based contrast agents by the ACR will likely have major financial implications.

Keywords: Cost analysis; eGFR screening; point-of-care eGFR evaluation; renal function screening; screening before contrast-enhanced MRI.