Department of Health and Human Services


OFFICE OF


INSPECTOR GENERAL


POCKET DOPPLERS


MANAGEMENT ADVISORY REPORT 

,.v 

Jrc Richard P. Kusserow 

INSPECfOR GENERA 

ltd3a MAY 1991 
.:. 

... . _.. ...__..__.__._. __ _. 

OFFICE OF INSPECfOR GENERA


The mission of the Office of Inspector Geperal(OI!3), as mandated by Public Law 95-452 

as amended, is to protect the integrity of the Department of Health and Human Servces (HHS) programs as well as the health and welfare of beneficiaries served by those programs. This statutory mission is carried out through a nationwide network of audits, investigations 

and inspections conducted by three OIG operating components: the Office of Audit 

Services, the Offce of Investigations, and the Office of Evaluation and Inspections. The OIG also informs the Secretary of HHS of program and management problems and 

recommends courses to correct them. 

OFFICE OF AUDIT SERVICE 

The OIG's Office of Audit Services (OAS) provides all auditing servces for HHS, either by conducting audits with its own audit resources or by overseeing audit work done by others. Audits examine the performance ofHHS programs and/or its grantees and contractors in carryng out their respective responsibilities and are intended toprdvide independent

assessments of HHS. programs and operations in order to reduce waste, abuse, and 

mismanagement and to promote economy and efficiency throughout the Department. 

OFFICE OF INTIGATIONS 

The OIG's Office of Investigations (01) conducts criminal, civil , and administrative investigations of allegations of wrongdoing in HHS programs or to HHS beneficiaries and of 

unjust enrichment by providers. The investigative efforts of 01 lead to criminal convictions 

administrative sanctions, or civil money penalties. The 01 also oversees State Medicaid fraud 

control units which investigate and prosecute fraud and patient abuse in the Medicaid 

program. 

OFFICE OF EVALUATION AN INSPECfONS 

The OIG's Office of Evaluation and Inspections (OEI) conducts short-term management and program evaluations (called inspections) that focus on issues of concern to the Department 

the Congress, and the public. The findings and recommendations contained in these 

inspection reports generate rapid, accurate, and up-to-date information on the effciency, 

vulnerability, and effectiveness of departmental programs. 

This report was prepared by the Philadelphia regional office under the direction 

of Joy Quill, Regional Inspector General and Robert A. Vito, Deputy Regional Inspector General. Project Staff: 

Robert A Katz Project Leader 

Cynthia R. Hansford 

W. Mark Krushat (Headquarters) 

Wayne A Powell 
,.

Department of Health and Human Services


OFFICE OF


INSPECTOR GENERAL


POCKET DOPPLERS


MANAGEMENT ADVISORY REPORT 

( J Richard P. Kusserow 

INSPECTOR GENERAL 

ltd3a OEI-03-91-00461 
PUROSE 

This report quantifies Medicare reimbursement for in-office ultrasound tests of arteries 

and veins conducted with inexpensive screening devices, popularly known as "Pocket 

Dopplers." This report is being provided for informational purposes only to advise the 

Health Care Financing Administration (HCF A) of potential savings resulting from its 

recent decision to prohibit reimbursement for Pocket Dopplers. 

BACKGROUN 

Pocket Dopplers are unsophisticated screening devices used by many medical 

practitioners to perform ultrasound tests of arteries and veins. A hand-held device, often 

shaped like a ballpoint pen, the tyical Pocket Doppler operates on a 9-volt battery. 

When activated, the instrument transmits a high frequency soundwave into the tissues. 

Analog waveform sounds (comparable to a stethoscope), reflected from internal organs or the flow of blood, change in frequency by an amount proportional to blood flow 

velocity. The reflected sound results in an audible signal. Typically, the Pocket Doppler 

is nondirectional (i. , it is incapable of determining the direction of blood flow) and 

produces audio signals only. Such tests can be conducted in less than 5 minutes. These 

devices are marketed as diagnostic ultrasound equipment and generally cost under 

000. 

Approximately 15 manufacturers produce and market Pocket Dopplers. Industry sources 

estimate that at least 100 000 units are in active use in the medical community. About 

000 new units were sold in 1990. 

Diagnostic ultrasound tests are usually conducted using "mid-level" equipment. This 

equipment costs from $15 000 to $60 000 and offers a wide range of sophisticated 

options, such as two-dimensional displays, computerized analysis, and color-flow imaging. 

More sophisticated devices produce video pictures of blood flow velocities in 

combinations of red, blue, and green. Changes in the intensity of color and blood flow 

velocity can indicate an irregularity, such as a blockage. 

Nationally, Medicare in-office allowances for four major procedure .codes used in 

diagnostic vascular ultrasound tests surpassed $88 milion in 1989, an increase of more 

than 31 percent over 1988. These tests reflect an increased frequency in allowed servces 

of approximately 25 percent for this I-year period. 
Our previous draft report (Low-Cost Ultrasound Equipment, OEI-03-88-01401) reviewed 

the appropriateness of Medicare reimbursement-for diagnostic tests conducted with such 

inexpensive screening devices. As a result of this study, we recommended that HCF A 

prohibit payment for tests conducted with Pocket Dopplers. The HCF A concurred with 

this recommendation. However, accurate information regarding potential savings was not 

available. 

METIODOLOY 

This report is based on a two-stage random sample consisting of 480 servces from 

Medicare carriers. We selected 60 servces per carrier from 1988 Part B Medicare 

Annual Data (BMA) bilings for in-office diagnostic vascular tests. We limited the 

servces to four commonly used procedure codes by practitioners of these tests. The 

codes are: 93910 (noninvasive studies of lower extremity arteries); 93950 (noninvasive 

studies of lower extremity veins); 93860 (noninvasive studies of carotid arteries); and 

93890 (noninvasive studies of upper extremity arteries). These procedure codes


represent only a portion of the number of codes for which Pocket Doppler servces could 

be biled. 

After receiving identifyng information from the carriers, we wrote to the practitioners 

requesting detailed data on the tyes of equipment used to conduct the tests. We 

reviewed the responses against pertinent information from scientific publications 

manufacturers' catalogs , and related technical materials to determine if Pocket Dopplers 

were used to conduct the tests. We consulted with a Registered Vascular Technologist 

who reviewed responses and assisted us in making determinations. 

FININGS 

Pocket Dopplers accounted for 7 percent of frequently performed in-office 

ultrasound servces in 1988.


Six-five percent of the providers in our sample (314 of 480) responded to our letters. 

Based on our analysis, 7 percent of the servces (22 responses) were performed with 

Pocket Dopplers. Medicare allowed $1 600 for these 22 servces. 

The number of allowed servces for the four procedure codes in our sample totaled 

561 800 in 1988. Applying the 7 percent usage rate and the 65 percent response rate, we 

calculate Pocket Dopplers were used for approximately 25 000 servces in 1988. 
,

If non-respondent usage rates were the same as respondent rates, total servces 

conducted by Pocket Dopplers could have been as high as 39 000 in 1988. 

Medicare allowed between $2 and $2.9 milion for Pocket Doppler servces in 

1988. 

The average Medicare allowance for Pocket Doppler servces in 1988 was $73.00. Based 

on our projection, we estimate that Medicare allowed $2 milion for Pocket Doppler 

servces in 1988. If non-respondents and respondents had the same usage rate, an 

additional $900 000 could have been allowed for 1988. 

By prohibiting payment for Pocket Doppler servces, we estimate savings of $30 

millon in Medicare allowances will be realized over a 5-year period. 

The HCFA has agreed to prohibit separate coverage for Pocket Doppler servces. 

assume this coverage decision will be effective by 1992. 

Our savings calculations are very conservative. In our calculations, we applied the 65 

percent response rate and the 7 percent Pocket Doppler usage rate to the 700 700 

allowed servces for the four procedure codes in 1989. Non-respondents were not 

included in our calculations even though there is no reason to suspect the usage rate for 

non-respondents differs from respondents. We assumed an annual 20 percent increase in 

the number of servces -- the actual annual increase from 1987 to 1989 was between 25 

and 30 percent. The 1988 average allowed amount of $73 per servce was used in all 5 

years. We omitted possible reimbursement increases because of recent legislative 

changes designed to minimize such increases. 

As shown in the chart below, we estimate that savings of $30 millon in Medicare 

allowances will be realized over the next 5 years. 

PROJECTED MEDICARE ALLOWANCES


FOR POCKET DOPPLERS 1992- 1996 

1992 1993 1994 1995 1996 

TOTAL SERVCES 210,810 1.452.972 1.743.566 092.279 510 735 

POCKE OOPPLE SERV. 55.092 66. 110 79,332 95. 199 114.238 

MEDICARE ALLOWANCES $4.021.716 $4,826.030 $5,791.236 $6.949.527 $8.339.374 

TOTAL' MEi5icA-RE'-AiC6wiNCES'- $29 927:8831