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Supplement for

“Changes in outpatient imaging utilization and spending under a new population-based primary care payment model”

Contents

Supplemental Materials 1. Description of Population-based Payments for Primary Care (3PC) in Hawaii

Supplemental Materials 2. List of current procedural terminology codes for radiology

Supplemental Materials 3. Propensity score model description

Supplemental Figure 1. Tests of Parallel Trends for Spending and Utilization Outcomes

Supplemental Table 1. Total Spending Results from Main Analysis

Supplemental Table 2. Unadjusted and Adjusted Differential Changes in Spending for Outpatient Imaging in the Population-based Payments for Primary Care (3PC) and Non 3PC (Fee-for-Service Comparison) Groups, 2012-2016

Supplemental Table 3. Relative Changes in Total Spending Comparing Health Plan Types for the 3PC vs. Non 3PC Groups, 2012–2016

Supplemental Table 4. Unadjusted and Adjusted Differential Changes in Utilization for Outpatient Imaging in the Population-based Payments for Primary Care (3PC) and Non 3PC (Fee-for-Service Comparison) Groups, 2012-2016

Supplemental Figure 2. Sensitivity Analysis with Exchangeable Working Correlation Structure

Supplemental Figure 3. Sensitivity Analysis with $0.01 Added to Outcomes

Supplemental Materials 1. Description of Population-based Payments for Primary Care (3PC) in Hawaii

In 2016, the Blue Cross Blue Shield of Hawaii, Hawaii Medical Service Association (HMSA), initiated a new primary care global payment system, Population-based Payments for Primary Care (3PC). Both adult and pediatric patients are covered under this model, with care provided by provider organizations (POs) and primary care physicians (PCPs) in internal medicine, pediatrics, and family medicine, as well as other e clinicians such as nurse practitioners and physician assistants.

Led by HMSA’s CEO and Chief Transformation Officer, this health plan-level initiative has a defined set of primary goals for its new system that includes: designing a health care delivery approach that is more conducive to sustainable cost growth; remodeling the financial and non-financial incentives for POs and PCPs to encourage patient-centered care; and controlling the rate of increase in cost of care. As part of this last goal, HMSA sought to reduce low-value services. One such target was high-cost imaging and imaging-based procedures. Because of perceptions of substantial overuse of these services, HMSA tried over the years to engage vendors in utilization management. These initiatives were rolled out over intervals from 2006 to 2015 across the entire network and primarily included precertification for the following: magnetic resonance imaging (MRI); magnetic resonance angiography and magnetic resonance spectroscopy; computed tomography (CT) and computed tomography angiography; nuclear cardiology; functional MRI; positron emission tomography; CT colonography; cardiac computed tomography angiography; and brain, liver, kidney, bone, and/or joint and cerebrospinal fluid flow imaging single positron emission computed tomography imaging.

Supplemental Materials 2. List of current procedural terminology codes for radiology

Current Procedural Terminology code Description Modality Series type YES=not a material

70010 Contrast x-ray of brain x-ray 70,000 series YES70015 Contrast x-ray of brain x-ray 70,000 series YES70030 X-ray eye for foreign body x-ray 70,000 series YES70100 X-ray exam of jaw <4views x-ray 70,000 series YES70110 X-ray exam of jaw 4/> views x-ray 70,000 series YES70120 X-ray exam of mastoids x-ray 70,000 series YES70130 X-ray exam of mastoids x-ray 70,000 series YES70134 X-ray exam of middle ear x-ray 70,000 series YES70140 X-ray exam of facial bones x-ray 70,000 series YES70150 X-ray exam of facial bones x-ray 70,000 series YES70160 X-ray exam of nasal bones x-ray 70,000 series YES70170 X-ray exam of tear duct x-ray 70,000 series YES70190 X-ray exam of eye sockets x-ray 70,000 series YES70200 X-ray exam of eye sockets x-ray 70,000 series YES70210 X-ray exam of sinuses x-ray 70,000 series YES70220 X-ray exam of sinuses x-ray 70,000 series YES70240 X-ray exam pituitary saddle x-ray 70,000 series YES70250 X-ray exam of skull x-ray 70,000 series YES70260 X-ray exam of skull x-ray 70,000 series YES70300 X-ray exam of teeth x-ray 70,000 series YES70310 X-ray exam of teeth x-ray 70,000 series YES70320 Full mouth x-ray of teeth x-ray 70,000 series YES70328 X-ray exam of jaw joint x-ray 70,000 series YES70330 X-ray exam of jaw joints x-ray 70,000 series YES70332 X-ray exam of jaw joint x-ray 70,000 series YES70336 Magnetic image jaw joint MRI 70,000 series YES70350 X-ray head for orthodontia x-ray 70,000 series YES70355 Panoramic x-ray of jaws x-ray 70,000 series YES70360 X-ray exam of neck x-ray 70,000 series YES70370 Throat x-ray & fluoroscopy x-ray 70,000 series YES70371 Speech evaluation complex procedure 70,000 series YES

70380 X-ray exam of salivary gland x-ray 70,000 series YES70390 X-ray exam of salivary duct x-ray 70,000 series YES70450 Ct head/brain w/o dye CT 70,000 series YES70460 Ct head/brain w/dye CT 70,000 series YES70470 Ct head/brain w/o & w/dye CT 70,000 series YES70480 Ct orbit/ear/fossa w/o dye CT 70,000 series YES70481 Ct orbit/ear/fossa w/dye CT 70,000 series YES

70482 Ct orbit/ear/fossa w/o&w/dye CT 70,000 series YES

70486 Ct maxillofacial w/o dye CT 70,000 series YES70487 Ct maxillofacial w/dye CT 70,000 series YES

70488 Ct maxillofacial w/o & w/dye CT 70,000 series YES

70490 Ct soft tissue neck w/o dye CT 70,000 series YES70491 Ct soft tissue neck w/dye CT 70,000 series YES70492 Ct sft tsue nck w/o & w/dye CT 70,000 series YES70496 Ct angiography head CT 70,000 series YES70498 Ct angiography neck CT 70,000 series YES70540 Mri orbit/face/neck w/o dye MRI 70,000 series YES70542 Mri orbit/face/neck w/dye MRI 70,000 series YES70543 Mri orbt/fac/nck w/o &w/dye MRI 70,000 series YES

70544 Mr angiography head w/o dye MRI 70,000 series YES

70545 Mr angiography head w/dye MRI 70,000 series YES

70546 Mr angiograph head w/o&w/dye MRI 70,000 series YES

70547 Mr angiography neck w/o dye MRI 70,000 series YES

70548 Mr angiography neck w/dye MRI 70,000 series YES

70549 Mr angiograph neck w/o&w/dye MRI 70,000 series YES

70551 Mri brain stem w/o dye MRI 70,000 series YES70552 Mri brain stem w/dye MRI 70,000 series YES70553 Mri brain stem w/o & w/dye MRI 70,000 series YES70554 Fmri brain by tech MRI 70,000 series YES70555 Fmri brain by phys/psych MRI 70,000 series YES70557 Mri brain w/o dye MRI 70,000 series YES

70558 Mri brain w/dye MRI 70,000 series YES70559 Mri brain w/o & w/dye MRI 70,000 series YES71100 X-ray exam ribs uni 2 views x-ray 70,000 series YES71101 X-ray exam unilat ribs/chest x-ray 70,000 series YES71110 X-ray exam ribs bil 3 views x-ray 70,000 series YES

71111 X-ray exam ribs/chest4/> vws x-ray 70,000 series YES

71120 X-ray exam breastbone 2/>vws x-ray 70,000 series YES

71130 X-ray strenoclavic jt 3/>vws x-ray 70,000 series YES71250 Ct thorax w/o dye CT 70,000 series YES71260 Ct thorax w/dye CT 70,000 series YES71270 Ct thorax w/o & w/dye CT 70,000 series YES71275 Ct angiography chest CT 70,000 series YES71550 Mri chest w/o dye MRI 70,000 series YES71551 Mri chest w/dye MRI 70,000 series YES71552 Mri chest w/o & w/dye MRI 70,000 series YES72020 X-ray exam of spine 1 view x-ray 70,000 series YES

72040 X-ray exam neck spine 2-3 vw x-ray 70,000 series YES

72050 X-ray exam neck spine 4/5vws x-ray 70,000 series YES

72052 X-ray exam neck spine 6/>vws x-ray 70,000 series YES

72070 X-ray exam thorac spine 2vws x-ray 70,000 series YES

72072 X-ray exam thorac spine 3vws x-ray 70,000 series YES

72074 X-ray exam thorac spine4/>vw x-ray 70,000 series YES

72080 X-ray exam thoracolmb 2/> vw x-ray 70,000 series YES

72081 X-ray exam entire spi 1 vw x-ray 70,000 series YES72082 X-ray exam entire spi 2/3 vw x-ray 70,000 series YES72083 X-ray exam entire spi 4/5 vw x-ray 70,000 series YES72084 X-ray exam entire spi 6/> vw x-ray 70,000 series YES72100 X-ray exam l-s spine 2/3 vws x-ray 70,000 series YES

72110 X-ray exam l-2 spine 4/>vws x-ray 70,000 series YES72114 X-ray exam l-s spine bending x-ray 70,000 series YES72120 X-ray bend only l-s spine x-ray 70,000 series YES72125 Ct neck spine w/o dye CT 70,000 series YES72126 Ct neck spine w/dye CT 70,000 series YES72127 Ct neck spine w/o & w/dye CT 70,000 series YES72128 Ct chest spine w/o dye CT 70,000 series YES72129 Ct chest spine w/dye CT 70,000 series YES72130 Ct chest spine w/o & w/dye CT 70,000 series YES72131 Ct lumbar spine w/o dye CT 70,000 series YES72132 Ct lumbar spine w/dye CT 70,000 series YES72133 Ct lumbar spine w/o & w/dye CT 70,000 series YES72141 Mri neck spine w/o dye MRI 70,000 series YES72142 Mri neck spine w/dye MRI 70,000 series YES72146 Mri chest spine w/o dye MRI 70,000 series YES72147 Mri chest spine w/dye MRI 70,000 series YES72148 Mri lumbar spine w/o dye MRI 70,000 series YES72149 Mri lumbar spine w/dye MRI 70,000 series YES72156 Mri neck spine w/o & w/dye MRI 70,000 series YES72157 Mri chest spine w/o & w/dye MRI 70,000 series YES

72158 Mri lumbar spine w/o & w/dye MRI 70,000 series YES

72170 X-ray exam of pelvis x-ray 70,000 series YES72190 X-ray exam of pelvis x-ray 70,000 series YES

72191 Ct angiograph pelv w/o&w/dye CT 70,000 series YES

72192 Ct pelvis w/o dye CT 70,000 series YES72193 Ct pelvis w/dye CT 70,000 series YES72194 Ct pelvis w/o & w/dye CT 70,000 series YES72195 Mri pelvis w/o dye MRI 70,000 series YES72196 Mri pelvis w/dye MRI 70,000 series YES72197 Mri pelvis w/o & w/dye MRI 70,000 series YES72198 Mr angio pelvis w/o & w/dye MRI 70,000 series YES72200 X-ray exam si joints x-ray 70,000 series YES72202 X-ray exam si joints 3/> vws x-ray 70,000 series YES72220 X-ray exam sacrum tailbone x-ray 70,000 series YES

72240 Myelography neck spine x-ray 70,000 series YES72255 Myelography thoracic spine x-ray 70,000 series YES72265 Myelography l-s spine x-ray 70,000 series YES72270 Myelogphy 2/> spine regions x-ray 70,000 series YES72275 Epidurography procedure 70,000 series YES72285 Discography cerv/thor spine procedure 70,000 series YES72295 X-ray of lower spine disk x-ray 70,000 series YES73000 X-ray exam of collar bone x-ray 70,000 series YES

73010 X-ray exam of shoulder blade x-ray 70,000 series YES

73020 X-ray exam of shoulder x-ray 70,000 series YES73030 X-ray exam of shoulder x-ray 70,000 series YES73040 Contrast x-ray of shoulder x-ray 70,000 series YES73050 X-ray exam of shoulders x-ray 70,000 series YES73060 X-ray exam of humerus x-ray 70,000 series YES73070 X-ray exam of elbow x-ray 70,000 series YES73080 X-ray exam of elbow x-ray 70,000 series YES73085 Contrast x-ray of elbow x-ray 70,000 series YES73090 X-ray exam of forearm x-ray 70,000 series YES73092 X-ray exam of arm infant x-ray 70,000 series YES73100 X-ray exam of wrist x-ray 70,000 series YES73110 X-ray exam of wrist x-ray 70,000 series YES73115 Contrast x-ray of wrist x-ray 70,000 series YES73120 X-ray exam of hand x-ray 70,000 series YES73130 X-ray exam of hand x-ray 70,000 series YES73140 X-ray exam of finger(s) x-ray 70,000 series YES73200 Ct upper extremity w/o dye CT 70,000 series YES73201 Ct upper extremity w/dye CT 70,000 series YES

73202 Ct uppr extremity w/o&w/dye CT 70,000 series YES

73206 Ct angio upr extrm w/o&w/dye CT 70,000 series YES

73218 Mri upper extremity w/o dye MRI 70,000 series YES73219 Mri upper extremity w/dye MRI 70,000 series YES

73220 Mri uppr extremity w/o&w/dye MRI 70,000 series YES

73221 Mri joint upr extrem w/o dye MRI 70,000 series YES73222 Mri joint upr extrem w/dye MRI 70,000 series YES

73223 Mri joint upr extr w/o&w/dye MRI 70,000 series YES

73501 X-ray exam hip uni 1 view x-ray 70,000 series YES

73502 X-ray exam hip uni 2-3 views x-ray 70,000 series YES

73503 X-ray exam hip uni 4/> views x-ray 70,000 series YES

73521 X-ray exam hips bi 2 views x-ray 70,000 series YES73522 X-ray exam hips bi 3-4 views x-ray 70,000 series YES73523 X-ray exam hips bi 5/> views x-ray 70,000 series YES73525 Contrast x-ray of hip x-ray 70,000 series YES73551 X-ray exam of femur 1 x-ray 70,000 series YES73552 X-ray exam of femur 2/> x-ray 70,000 series YES73560 X-ray exam of knee 1 or 2 x-ray 70,000 series YES73562 X-ray exam of knee 3 x-ray 70,000 series YES73564 X-ray exam knee 4 or more x-ray 70,000 series YES73565 X-ray exam of knees x-ray 70,000 series YES73580 Contrast x-ray of knee joint x-ray 70,000 series YES73590 X-ray exam of lower leg x-ray 70,000 series YES73592 X-ray exam of leg infant x-ray 70,000 series YES73600 X-ray exam of ankle x-ray 70,000 series YES73610 X-ray exam of ankle x-ray 70,000 series YES73615 Contrast x-ray of ankle x-ray 70,000 series YES73620 X-ray exam of foot x-ray 70,000 series YES73630 X-ray exam of foot x-ray 70,000 series YES73650 X-ray exam of heel x-ray 70,000 series YES73660 X-ray exam of toe(s) x-ray 70,000 series YES73700 Ct lower extremity w/o dye CT 70,000 series YES73701 Ct lower extremity w/dye CT 70,000 series YES73702 Ct lwr extremity w/o&w/dye CT 70,000 series YES73706 Ct angio lwr extr w/o&w/dye CT 70,000 series YES73718 Mri lower extremity w/o dye MRI 70,000 series YES73719 Mri lower extremity w/dye MRI 70,000 series YES73720 Mri lwr extremity MRI 70,000 series YES

w/o&w/dye73721 Mri jnt of lwr extre w/o dye MRI 70,000 series YES73722 Mri joint of lwr extr w/dye MRI 70,000 series YES

73723 Mri joint lwr extr w/o&w/dye MRI 70,000 series YES

74022 X-ray exam series abdomen x-ray 70,000 series YES74150 Ct abdomen w/o dye CT 70,000 series YES74160 Ct abdomen w/dye CT 70,000 series YES74170 Ct abdomen w/o & w/dye CT 70,000 series YES

74174 Ct angio abd&pelv w/o&w/dye CT 70,000 series YES

74175 Ct angio abdom w/o & w/dye CT 70,000 series YES74176 Ct abd & pelvis w/o contrast CT 70,000 series YES74177 Ct abd & pelv w/contrast CT 70,000 series YES74178 Ct abd & pelv 1/> regns CT 70,000 series YES74181 Mri abdomen w/o dye MRI 70,000 series YES74182 Mri abdomen w/dye MRI 70,000 series YES74183 Mri abdomen w/o & w/dye MRI 70,000 series YES74190 X-ray exam of peritoneum x-ray 70,000 series YES74210 Contrst x-ray exam of throat x-ray 70,000 series YES74220 Contrast x-ray esophagus x-ray 70,000 series YES74230 Cine/vid x-ray throat/esoph x-ray 70,000 series YES

74235 Remove esophagus obstruction procedure 70,000 series YES

74240 X-ray upper gi delay w/o kub x-ray 70,000 series YES74241 X-ray upper gi delay w/kub x-ray 70,000 series YES74245 X-ray upper gi&small intest x-ray 70,000 series YES74246 Contrst x-ray uppr gi tract x-ray 70,000 series YES74247 Contrst x-ray uppr gi tract x-ray 70,000 series YES74249 Contrst x-ray uppr gi tract x-ray 70,000 series YES74250 X-ray exam of small bowel x-ray 70,000 series YES74251 X-ray exam of small bowel x-ray 70,000 series YES74260 X-ray exam of small bowel x-ray 70,000 series YES74261 Ct colonography dx CT 70,000 series YES74262 Ct colonography dx w/dye CT 70,000 series YES74270 Contrast x-ray exam of colon x-ray 70,000 series YES

74280 Contrast x-ray exam of colon x-ray 70,000 series YES74283 Contrast x-ray exam of colon x-ray 70,000 series YES74290 Contrast x-ray gallbladder x-ray 70,000 series YES74300 X-ray bile ducts/pancreas x-ray 70,000 series YES74301 X-rays at surgery add-on x-ray 70,000 series YES74328 X-ray bile duct endoscopy x-ray 70,000 series YES

74329 X-ray for pancreas endoscopy x-ray 70,000 series YES

74330 X-ray bile/panc endoscopy x-ray 70,000 series YES74340 X-ray guide for gi tube x-ray 70,000 series YES74355 X-ray guide intestinal tube x-ray 70,000 series YES74360 X-ray guide gi dilation x-ray 70,000 series YES74363 X-ray bile duct dilation x-ray 70,000 series YES74400 Contrst x-ray urinary tract x-ray 70,000 series YES74410 Contrst x-ray urinary tract x-ray 70,000 series YES74415 Contrst x-ray urinary tract x-ray 70,000 series YES74420 Contrst x-ray urinary tract x-ray 70,000 series YES74425 Contrst x-ray urinary tract x-ray 70,000 series YES74430 Contrast x-ray bladder x-ray 70,000 series YES74440 X-ray male genital tract x-ray 70,000 series YES74445 X-ray exam of penis x-ray 70,000 series YES74450 X-ray urethra/bladder x-ray 70,000 series YES74455 X-ray urethra/bladder x-ray 70,000 series YES74470 X-ray exam of kidney lesion x-ray 70,000 series YES74485 X-ray guide gu dilation x-ray 70,000 series YES74710 X-ray measurement of pelvis x-ray 70,000 series YES74712 Mri fetal sngl/1st gestation MRI 70,000 series YES74713 Mri fetal ea addl gestation MRI 70,000 series YES74740 X-ray female genital tract x-ray 70,000 series YES74742 X-ray fallopian tube x-ray 70,000 series YES74775 X-ray exam of perineum x-ray 70,000 series YES75557 Cardiac mri for morph MRI 70,000 series YES75559 Cardiac mri w/stress img MRI 70,000 series YES75561 Cardiac mri for morph w/dye MRI 70,000 series YES75563 Card mri w/stress img & dye MRI 70,000 series YES75565 Card mri veloc flow mapping MRI 70,000 series YES

75571 Ct hrt w/o dye w/ca test CT 70,000 series YES75572 Ct hrt w/3d image CT 70,000 series YES75573 Ct hrt w/3d image congen CT 70,000 series YES75574 Ct angio hrt w/3d image CT 70,000 series YES75600 Contrast exam thoracic aorta CT 70,000 series YES75605 Contrast exam thoracic aorta CT 70,000 series YES

75625 Contrast exam abdominl aorta CT 70,000 series YES

75630 X-ray aorta leg arteries x-ray 70,000 series YES75635 Ct angio abdominal arteries CT 70,000 series YES75705 Artery x-rays spine x-ray 70,000 series YES75710 Artery x-rays arm/leg x-ray 70,000 series YES75716 Artery x-rays arms/legs x-ray 70,000 series YES75726 Artery x-rays abdomen x-ray 70,000 series YES75731 Artery x-rays adrenal gland x-ray 70,000 series YES75733 Artery x-rays adrenals x-ray 70,000 series YES75736 Artery x-rays pelvis x-ray 70,000 series YES75741 Artery x-rays lung x-ray 70,000 series YES75743 Artery x-rays lungs x-ray 70,000 series YES75746 Artery x-rays lung x-ray 70,000 series YES75756 Artery x-rays chest x-ray 70,000 series YES75774 Artery x-ray each vessel x-ray 70,000 series YES75801 Lymph vessel x-ray arm/leg x-ray 70,000 series YES

75803 Lymph vessel x-ray arms/legs x-ray 70,000 series YES

75805 Lymph vessel x-ray trunk x-ray 70,000 series YES75807 Lymph vessel x-ray trunk x-ray 70,000 series YES75809 Nonvascular shunt x-ray x-ray 70,000 series YES75810 Vein x-ray spleen/liver x-ray 70,000 series YES75820 Vein x-ray arm/leg x-ray 70,000 series YES75822 Vein x-ray arms/legs x-ray 70,000 series YES75825 Vein x-ray trunk x-ray 70,000 series YES75827 Vein x-ray chest x-ray 70,000 series YES75831 Vein x-ray kidney x-ray 70,000 series YES75833 Vein x-ray kidneys x-ray 70,000 series YES75840 Vein x-ray adrenal gland x-ray 70,000 series YES

75842 Vein x-ray adrenal glands x-ray 70,000 series YES75860 Vein x-ray neck x-ray 70,000 series YES75870 Vein x-ray skull x-ray 70,000 series YES75872 Vein x-ray skull epidural x-ray 70,000 series YES75880 Vein x-ray eye socket x-ray 70,000 series YES

75885 Vein x-ray liver w/hemodynam x-ray 70,000 series YES

75887 Vein x-ray liver w/o hemodyn x-ray 70,000 series YES

75889 Vein x-ray liver w/hemodynam x-ray 70,000 series YES

75891 Vein x-ray liver x-ray 70,000 series YES75893 Venous sampling by catheter procedure 70,000 series YES75894 X-rays transcath therapy x-ray 70,000 series YES75898 Follow-up angiography x-ray 70,000 series YES75901 Remove cva device obstruct procedure 70,000 series YES75902 Remove cva lumen obstruct procedure 70,000 series YES75956 Xray endovasc thor ao repr x-ray 70,000 series YES75957 Xray endovasc thor ao repr x-ray 70,000 series YES75958 Xray place prox ext thor ao x-ray 70,000 series YES75959 Xray place dist ext thor ao x-ray 70,000 series YES75970 Vascular biopsy procedure 70,000 series YES75984 Xray control catheter change x-ray 70,000 series YES75989 Abscess drainage under x-ray x-ray 70,000 series YES76000 Fluoroscope examination x-ray 70,000 series YES76001 Fluoroscope exam extensive x-ray 70,000 series YES76010 X-ray nose to rectum x-ray 70,000 series YES76080 X-ray exam of fistula x-ray 70,000 series YES76098 X-ray exam breast specimen x-ray 70,000 series YES76100 X-ray exam of body section x-ray 70,000 series YES76101 Complex body section x-ray x-ray 70,000 series YES76102 Complex body section x-rays x-ray 70,000 series YES76120 Cine/video x-rays x-ray 70,000 series YES76125 Cine/video x-rays add-on x-ray 70,000 series YES76376 3d render w/intrp postproces other imaging 70,000 series YES76377 3d render w/intrp postproces other imaging 70,000 series YES

76380 Cat scan follow-up study CT 70,000 series YES76506 Echo exam of head US 70,000 series YES76510 Ophth us b & quant a US 70,000 series YES76511 Ophth us quant a only US 70,000 series YES76512 Ophth us b w/non-quant a US 70,000 series YES76513 Echo exam of eye water bath US 70,000 series YES76514 Echo exam of eye thickness US 70,000 series YES76516 Echo exam of eye US 70,000 series YES76519 Echo exam of eye US 70,000 series YES76529 Echo exam of eye US 70,000 series YES76536 Us exam of head and neck US 70,000 series YES76604 Us exam chest US 70,000 series YES76641 Ultrasound breast complete US 70,000 series YES76642 Ultrasound breast limited US 70,000 series YES76700 Us exam abdom complete US 70,000 series YES76705 Echo exam of abdomen US 70,000 series YES76706 Us abdl aorta screen aaa US 70,000 series YES

76770 Us exam abdo back wall comp US 70,000 series YES

76775 Us exam abdo back wall lim US 70,000 series YES76776 Us exam k transpl w/doppler US 70,000 series YES76800 Us exam spinal canal US 70,000 series YES76801 Ob us < 14 wks single fetus US 70,000 series YES76802 Ob us < 14 wks addl fetus US 70,000 series YES76805 Ob us >/= 14 wks sngl fetus US 70,000 series YES76810 Ob us >/= 14 wks addl fetus US 70,000 series YES76811 Ob us detailed sngl fetus US 70,000 series YES76812 Ob us detailed addl fetus US 70,000 series YES76813 Ob us nuchal meas 1 gest US 70,000 series YES76814 Ob us nuchal meas add-on US 70,000 series YES76815 Ob us limited fetus(s) US 70,000 series YES76816 Ob us follow-up per fetus US 70,000 series YES76817 Transvaginal us obstetric US 70,000 series YES76818 Fetal biophys profile w/nst procedure 70,000 series YES76819 Fetal biophys profil w/o nst procedure 70,000 series YES76820 Umbilical artery echo US 70,000 series YES

76821 Middle cerebral artery echo US 70,000 series YES76825 Echo exam of fetal heart US 70,000 series YES76826 Echo exam of fetal heart US 70,000 series YES76827 Echo exam of fetal heart US 70,000 series YES76828 Echo exam of fetal heart US 70,000 series YES76830 Transvaginal us non-ob US 70,000 series YES76831 Echo exam uterus US 70,000 series YES76856 Us exam pelvic complete US 70,000 series YES76857 Us exam pelvic limited US 70,000 series YES76870 Us exam scrotum US 70,000 series YES76872 Us transrectal US 70,000 series YES76873 Echograp trans r pros study US 70,000 series YES76881 Us xtr non-vasc complete US 70,000 series YES76882 Us xtr non-vasc lmtd US 70,000 series YES76885 Us exam infant hips dynamic US 70,000 series YES76886 Us exam infant hips static US 70,000 series YES76930 Echo guide cardiocentesis procedure 70,000 series YES76932 Echo guide for heart biopsy procedure 70,000 series YES76936 Echo guide for artery repair procedure 70,000 series YES76937 Us guide vascular access US 70,000 series YES76940 Us guide tissue ablation US 70,000 series YES76941 Echo guide for transfusion procedure 70,000 series YES76942 Echo guide for biopsy procedure 70,000 series YES76945 Echo guide villus sampling procedure 70,000 series YES76946 Echo guide for amniocentesis procedure 70,000 series YES76948 Echo guide ova aspiration procedure 70,000 series YES76965 Echo guidance radiotherapy procedure 70,000 series YES76970 Ultrasound exam follow-up US 70,000 series YES76975 Gi endoscopic ultrasound US 70,000 series YES76977 Us bone density measure US 70,000 series YES76998 Us guide intraop US 70,000 series YES77001 Fluoroguide for vein device procedure 70,000 series YES77002 Needle localization by xray x-ray 70,000 series YES77003 Fluoroguide for spine inject procedure 70,000 series YES77011 Ct scan for localization CT 70,000 series YES

77012 Ct scan for needle biopsy CT 70,000 series YES77013 Ct guide for tissue ablation CT 70,000 series YES77014 Ct scan for therapy guide CT 70,000 series YES77021 Mr guidance for needle place procedure 70,000 series YES77022 Mri for tissue ablation MRI 70,000 series YES77053 X-ray of mammary duct x-ray 70,000 series YES77054 X-ray of mammary ducts x-ray 70,000 series YES77058 Mri one breast MRI 70,000 series YES77059 Mri both breasts MRI 70,000 series YES77063 Breast tomosynthesis bi x-ray 70,000 series YES77065 Dx mammo incl cad uni x-ray 70,000 series YES77066 Dx mammo incl cad bi x-ray 70,000 series YES77067 Scr mammo bi incl cad x-ray 70,000 series YES77071 X-ray stress view x-ray 70,000 series YES77072 X-rays for bone age x-ray 70,000 series YES77073 X-rays bone length studies x-ray 70,000 series YES77074 X-rays bone survey limited x-ray 70,000 series YES77075 X-rays bone survey complete x-ray 70,000 series YES77076 X-rays bone survey infant x-ray 70,000 series YES77077 Joint survey single view x-ray 70,000 series YES77078 Ct bone density axial CT 70,000 series YES77080 Dxa bone density axial x-ray 70,000 series YES77081 Dxa bone density/peripheral x-ray 70,000 series YES

77084 Magnetic image bone marrow MRI 70,000 series YES

77085 Dxa bone density study x-ray 70,000 series YES77086 Fracture assessment via dxa x-ray 70,000 series YES77261 Radiation therapy planning procedure 70,000 series YES77262 Radiation therapy planning procedure 70,000 series YES77263 Radiation therapy planning procedure 70,000 series YES77280 Set radiation therapy field procedure 70,000 series YES77285 Set radiation therapy field procedure 70,000 series YES77290 Set radiation therapy field procedure 70,000 series YES

77293 Respirator motion mgmt simul procedure 70,000 series YES

77295 3-d radiotherapy plan procedure 70,000 series YES

77300 Radiation therapy dose plan procedure 70,000 series YES77301 Radiotherapy dose plan imrt procedure 70,000 series YES77306 Telethx isodose plan simple procedure 70,000 series YES77307 Telethx isodose plan cplx procedure 70,000 series YES77316 Brachytx isodose plan simple procedure 70,000 series YES77317 Brachytx isodose intermed procedure 70,000 series YES77318 Brachytx isodose complex procedure 70,000 series YES77321 Special teletx port plan procedure 70,000 series YES77331 Special radiation dosimetry procedure 70,000 series YES77332 Radiation treatment aid(s) procedure 70,000 series YES77333 Radiation treatment aid(s) procedure 70,000 series YES77334 Radiation treatment aid(s) procedure 70,000 series YES77336 Radiation physics consult other imaging 70,000 series YES77338 Design mlc device for imrt procedure 70,000 series YES77370 Radiation physics consult other imaging 70,000 series YES77372 Srs linear based procedure 70,000 series YES77373 Sbrt delivery procedure 70,000 series YES77401 Radiation treatment delivery procedure 70,000 series YES77417 Radiology port images(s) procedure 70,000 series YES77427 Radiation tx management x5 procedure 70,000 series YES

77431 Radiation therapy management procedure 70,000 series YES

77432 Stereotactic radiation trmt procedure 70,000 series YES77435 Sbrt management procedure 70,000 series YES77469 Io radiation tx management procedure 70,000 series YES77470 Special radiation treatment procedure 70,000 series YES77750 Infuse radioactive materials procedure 70,000 series YES77761 Apply intrcav radiat simple procedure 70,000 series YES77762 Apply intrcav radiat interm procedure 70,000 series YES77763 Apply intrcav radiat compl procedure 70,000 series YES77767 Hdr rdncl skn surf brachytx procedure 70,000 series YES77768 Hdr rdncl skn surf brachytx procedure 70,000 series YES77770 Hdr rdncl ntrstl/icav brchtx procedure 70,000 series YES77771 Hdr rdncl ntrstl/icav brchtx procedure 70,000 series YES77772 Hdr rdncl ntrstl/icav brchtx procedure 70,000 series YES77778 Apply interstit radiat compl procedure 70,000 series YES

77789 Apply surf ldr radionuclide procedure 70,000 series YES77790 Radiation handling procedure 70,000 series YES78012 Thyroid uptake measurement nuclear medicine 70,000 series YES

78013 Thyroid imaging w/blood flow nuclear medicine 70,000 series YES

78014 Thyroid imaging w/blood flow nuclear medicine 70,000 series YES

78015 Thyroid met imaging nuclear medicine 70,000 series YES78016 Thyroid met imaging/studies nuclear medicine 70,000 series YES78018 Thyroid met imaging body nuclear medicine 70,000 series YES78020 Thyroid met uptake nuclear medicine 70,000 series YES78070 Parathyroid planar imaging nuclear medicine 70,000 series YES78071 Parathyrd planar w/wo subtrj nuclear medicine 70,000 series YES78072 Parathyrd planar w/spect&ct nuclear medicine 70,000 series YES

78075 Adrenal cortex & medulla img nuclear medicine 70,000 series YES

78102 Bone marrow imaging ltd nuclear medicine 70,000 series YES78103 Bone marrow imaging mult nuclear medicine 70,000 series YES78104 Bone marrow imaging body nuclear medicine 70,000 series YES78110 Plasma volume single nuclear medicine 70,000 series YES78111 Plasma volume multiple nuclear medicine 70,000 series YES78120 Red cell mass single nuclear medicine 70,000 series YES78121 Red cell mass multiple nuclear medicine 70,000 series YES78122 Blood volume nuclear medicine 70,000 series YES78130 Red cell survival study nuclear medicine 70,000 series YES78135 Red cell survival kinetics nuclear medicine 70,000 series YES78140 Red cell sequestration nuclear medicine 70,000 series YES78185 Spleen imaging nuclear medicine 70,000 series YES78191 Platelet survival nuclear medicine 70,000 series YES78195 Lymph system imaging nuclear medicine 70,000 series YES78201 Liver imaging nuclear medicine 70,000 series YES78202 Liver imaging with flow nuclear medicine 70,000 series YES78205 Liver imaging (3d) nuclear medicine 70,000 series YES78206 Liver image (3d) with flow nuclear medicine 70,000 series YES78215 Liver and spleen imaging nuclear medicine 70,000 series YES78216 Liver & spleen image/flow nuclear medicine 70,000 series YES

78226 Hepatobiliary system imaging nuclear medicine 70,000 series YES

78227 Hepatobil syst image w/drug nuclear medicine 70,000 series YES78230 Salivary gland imaging nuclear medicine 70,000 series YES78231 Serial salivary imaging nuclear medicine 70,000 series YES78232 Salivary gland function exam nuclear medicine 70,000 series YES78258 Esophageal motility study nuclear medicine 70,000 series YES78261 Gastric mucosa imaging nuclear medicine 70,000 series YES

78262 Gastroesophageal reflux exam nuclear medicine 70,000 series YES

78264 Gastric emptying imag study nuclear medicine 70,000 series YES78265 Gastric emptying imag study nuclear medicine 70,000 series YES78266 Gastric emptying imag study nuclear medicine 70,000 series YES78270 Vit b-12 absorption exam nuclear medicine 70,000 series YES78271 Vit b-12 absrp exam int fac nuclear medicine 70,000 series YES78272 Vit b-12 absorp combined nuclear medicine 70,000 series YES78278 Acute gi blood loss imaging nuclear medicine 70,000 series YES78282 Gi protein loss exam nuclear medicine 70,000 series YES78290 Meckels divert exam nuclear medicine 70,000 series YES78291 Leveen/shunt patency exam nuclear medicine 70,000 series YES78300 Bone imaging limited area nuclear medicine 70,000 series YES78305 Bone imaging multiple areas nuclear medicine 70,000 series YES78306 Bone imaging whole body nuclear medicine 70,000 series YES78315 Bone imaging 3 phase nuclear medicine 70,000 series YES78320 Bone imaging (3d) nuclear medicine 70,000 series YES78414 Non-imaging heart function nuclear medicine 70,000 series YES78428 Cardiac shunt imaging nuclear medicine 70,000 series YES78445 Vascular flow imaging nuclear medicine 70,000 series YES78451 Ht muscle image spect sing nuclear medicine 70,000 series YES78452 Ht muscle image spect mult nuclear medicine 70,000 series YES78453 Ht muscle image planar sing nuclear medicine 70,000 series YES78454 Ht musc image planar mult nuclear medicine 70,000 series YES

78456 Acute venous thrombus image nuclear medicine 70,000 series YES

78457 Venous thrombosis imaging x-ray 70,000 series YES78458 Ven thrombosis images bilat x-ray 70,000 series YES

78459 Heart muscle imaging (pet) nuclear medicine 70,000 series YES78466 Heart infarct image nuclear medicine 70,000 series YES78468 Heart infarct image (ef) nuclear medicine 70,000 series YES78469 Heart infarct image (3d) nuclear medicine 70,000 series YES78472 Gated heart planar single nuclear medicine 70,000 series YES78473 Gated heart multiple nuclear medicine 70,000 series YES78481 Heart first pass single nuclear medicine 70,000 series YES78483 Heart first pass multiple nuclear medicine 70,000 series YES78491 Heart image (pet) single nuclear medicine 70,000 series YES78492 Heart image (pet) multiple nuclear medicine 70,000 series YES78494 Heart image spect nuclear medicine 70,000 series YES78496 Heart first pass add-on nuclear medicine 70,000 series YES78579 Lung ventilation imaging nuclear medicine 70,000 series YES78580 Lung perfusion imaging nuclear medicine 70,000 series YES

78582 Lung ventilat&perfus imaging nuclear medicine 70,000 series YES

78597 Lung perfusion differential nuclear medicine 70,000 series YES78598 Lung perf&ventilat diferentl nuclear medicine 70,000 series YES78600 Brain image < 4 views nuclear medicine 70,000 series YES

78601 Brain image w/flow < 4 views nuclear medicine 70,000 series YES

78605 Brain image 4+ views nuclear medicine 70,000 series YES

78606 Brain image w/flow 4 + views nuclear medicine 70,000 series YES

78607 Brain imaging (3d) nuclear medicine 70,000 series YES78608 Brain imaging (pet) nuclear medicine 70,000 series YES78610 Brain flow imaging only nuclear medicine 70,000 series YES78630 Cerebrospinal fluid scan nuclear medicine 70,000 series YES78635 Csf ventriculography nuclear medicine 70,000 series YES78645 Csf shunt evaluation nuclear medicine 70,000 series YES78647 Cerebrospinal fluid scan nuclear medicine 70,000 series YES78650 Csf leakage imaging nuclear medicine 70,000 series YES78660 Nuclear exam of tear flow nuclear medicine 70,000 series YES78700 Kidney imaging morphol nuclear medicine 70,000 series YES78701 Kidney imaging with flow nuclear medicine 70,000 series YES78707 K flow/funct image w/o drug nuclear medicine 70,000 series YES

78708 K flow/funct image w/drug nuclear medicine 70,000 series YES78709 K flow/funct image multiple nuclear medicine 70,000 series YES78710 Kidney imaging (3d) nuclear medicine 70,000 series YES78725 Kidney function study nuclear medicine 70,000 series YES78730 Urinary bladder retention nuclear medicine 70,000 series YES78740 Ureteral reflux study nuclear medicine 70,000 series YES78761 Testicular imaging w/flow nuclear medicine 70,000 series YES78800 Tumor imaging limited area nuclear medicine 70,000 series YES78801 Tumor imaging mult areas nuclear medicine 70,000 series YES78802 Tumor imaging whole body nuclear medicine 70,000 series YES78803 Tumor imaging (3d) nuclear medicine 70,000 series YES78804 Tumor imaging whole body nuclear medicine 70,000 series YES78805 Abscess imaging ltd area nuclear medicine 70,000 series YES78806 Abscess imaging whole body nuclear medicine 70,000 series YES78807 Nuclear localization/abscess nuclear medicine 70,000 series YES78808 Iv inj ra drug dx study procedure 70,000 series YES78811 Pet image ltd area nuclear medicine 70,000 series YES78812 Pet image skull-thigh nuclear medicine 70,000 series YES78813 Pet image full body nuclear medicine 70,000 series YES78814 Pet image w/ct lmtd nuclear medicine 70,000 series YES78815 Pet image w/ct skull-thigh nuclear medicine 70,000 series YES78816 Pet image w/ct full body nuclear medicine 70,000 series YES79005 Nuclear rx oral admin nuclear medicine 70,000 series YES79101 Nuclear rx iv admin nuclear medicine 70,000 series YES79200 Nuclear rx intracav admin nuclear medicine 70,000 series YES79300 Nuclr rx interstit colloid nuclear medicine 70,000 series YES79403 Hematopoietic nuclear tx nuclear medicine 70,000 series YES79440 Nuclear rx intra-articular nuclear medicine 70,000 series YES79445 Nuclear rx intra-arterial nuclear medicine 70,000 series YES

71010 Radiologic examination, chest; single view, frontal x-ray 70,000 series YES

71015 Radiologic examination, chest; stereo, frontal x-ray 70,000 series YES

71020Radiologic examination, chest, two views, frontal and lateral

x-ray 70,000 series YES

71021

Radiologic examination, chest, two views, frontal and lateral; with apical lordotic procedure


71022

Radiologic examination, chest, two views, frontal and lateral; with oblique projections


71023Radiologic examination, chest, two views, frontal and lateral; with fluoroscopy


71030Radiologic examination, chest, complete, minimum of four views


71034Radiologic examination, chest, complete, minimum of four views; with fluoroscopy


71035

Radiologic examination, chest, special views (eg, lateral decubitus, Bucky studies)


74020

Radiologic examination, abdomen; complete, including decubitus and/or erect views


74022

Radiologic examination, abdomen; complete acute abdomen series, including supine, erect, and/or decubitus views, single view chest


74010

Radiologic examination, abdomen; anteroposterior and additional oblique and cone views


74000Radiologic examination, abdomen; single anteroposterior view


Supplemental Materials 3. Propensity score model description

Spending outcomes were analyzed using propensity-weighted generalized linear models with a log link and gamma distribution, and utilization outcomes were analyzed using propensity-weighted unconditional negative binomial models to account for overdispersion. The propensity model included age, sex, and risk score (ERG, episode risk group).

Supplemental Figure 1. Tests of Parallel Trends for Spending and Utilization Outcomes

These graphs show the results of generalized linear regression models for each outcome as the dependent variable, and independent variables of time (year) fixed effects, pilot indicator variable, and the interaction with covariates included in the main regression models. Spending models used a log link and gamma distribution; utilization models used identity link and normal distribution (i.e. ordinary least squares). The estimates show that most interaction term coefficients are not statistically significant, indicating a lack of divergent trends in the pre-period for the outcome variables.

Abbreviations: CT=computed tomography; MRI=magnetic resonance imaging; US=ultrasound.

Supplemental Table 1. Total Spending Results from Main Analysis

Difference-in-Differences Estimate (95% CI) P-valueTotal spending 1.01 (0.98 to 1.04) 0.54Total spending by year

2013 0.53 (0.51 to 0.56) <0.0012014 0.53 (0.51 to 0.56) <0.0012015 0.52 (0.49 to 0.54) <0.0012016 0.44 (0.42 to 0.46) <0.001

Primary Care Physician CharacteristicsGender

Womena 1.05 (1.02 to 1.09) 0.003Specialtyb

Family medicine 1.26 (1.17 to 1.36) <0.001General practitioner 1.39 (1.28 to 1.51) <0.001

Internal medicine 1.31 (1.21 to 1.42) <0.001Residency training program locationc

Hawaii 1.02 (1.00 to 1.03) 0.08Medical school: Hawaii vs. otherc

Hawaii 1.00 (0.98 to 1.02) 0.81International 0.96 (0.94 to 0.99) 0.004

Physicians in physician organization 1.00 (1.00 to 1.00) <0.001

Practice site in urban zip code 0.97 (0.90 to 1.05) 0.44Primary Care Physician Panel Characteristics

Patient age 1.00 (1.00 to 1.00) 0.11Women patients 1.00 (1.00 to 1.00) 0.07

Panel size of unique patients 0.99 (0.99 to 1.00) <0.001Patient panel ERG score 1.05 (1.03 to 1.07) <0.001

Share of health plan type in the panelMedicaid 0.99 (0.99 to 1.00) <0.001

Commercial 1.00 (1.00 to 1.00) <0.001Patient Characteristics

Health plan typed

Medicare Advantage 1.71 (1.67 to 1.74) <0.001Commercial 0.59 (0.57 to 0.62) <0.001

Age (years)e

<18 0.83 (0.78 to 0.88) <0.00118 to 34 0.72 (0.69 to 0.76) <0.00135 to 49 1.10 (1.07 to 1.14) <0.00150 to 64 1.49 (1.45 to 1.53) <0.001

Gendera

Women 1.26 (1.24 to 1.29) <0.001Gender interacted with age (years)a,e

Women, <18 0.74 (0.69 to 0.78) <0.001Women, 18 to 34 1.74 (1.66 to 1.83) <0.001Women, 35 to 49 2.04 (1.97 to 2.12) <0.001Women, 50 to 64 1.66 (1.61 to 1.71) <0.001

ERG score 1.37 (1.37 to 1.37) <0.001Residence in an urban zip code 1.13 (1.05 to 1.22) <0.001

Bachelor’s or high school degree at zip level 1.00 (1.00 to 1.00) <0.001

Median household income by zip 0.99 (0.99 to 1.00) 0.02aReference group=Men. bReference group=Pediatrics. cReference group=United States (excluding Hawaii). dReference group=Medicaid. eReference group=Age > 65.

Supplemental Table 2. Unadjusted and Adjusted Differential Changes in Spending for Outpatient Imaging in the Population-based Payments for Primary Care (3PC) and Non 3PC (Fee-for-Service Comparison) Groups, 2012-2016

3PC Group Non 3PC Group

Pre-intervention, 2012-2015

Post-intervention

, 2016Difference


Post-intervention

, 2016Difference

Unadjusted Differential Change, $

(%)

P-Value

Adjusted Differential Change, %(95% CI)

P-Value Adjusted P-value

Total spending per 1 patient per year, mean $ (SD)

211 (528) 197 (528) -14 183 (512) 172 (508) -10 -3 (-1.5) 0.22 1.0(-2.0 to 4.0) 0.54 NA

Spending by modality per 1 patient per year, mean $ (SD)

CT 41 (215) 38 (226) -3 36 (210) 34 (208) -2 -1 (-2.0) 0.44 -1.0 (-7.4 to 5.9) 0.78 >0.99

MRI 47 (264) 39 (243) -8 42 (263) 35 (241) -7 -1 (-2.5) 0.37 0.2 (-6.9 to 7.8) 0.96 >0.99

Nuclear medicine 19 (163) 14 (162) -6 13 (141) 11 (148) -2 -3 (-18) <0.001

-20.1 (-27.5 to

-12.1)<0.001 <0.001

US 48 (168) 50 (167) 2 41 (161) 43 (157) 2 0 (0.5) 0.79 3.7 (-1.0 to 8.6) 0.12 0.50

X-ray 54 (108) 55 (108) 1 49 (105) 48 (103) -1 2 (3.6) <0.001 5.6 (2.6 to 8.7) <0.001 <0.001

Other 1.3 (30.0) 1.5 (32.8) 0.3 1.1 (28.0) 1.3 (29.7) 0.2 0.1 (5.5) 0.63 -1.3 (-6.8 to 4.6) 0.67 >0.99

Abbreviations: 3PC=Population-based Payments for Primary Care Intervention; CI=confidence interval; CT=computed tomography; MRI=magnetic resonance imaging; SD=standard deviation; US=ultrasound.

Supplemental Table 3. Relative Changes in Total Spending Comparing Health Plan Types for the 3PC vs. Non 3PC Groups, 2012–2016

Differential Change, % (95% CI) P-ValueMedicaida -3.3 (-13.8 to 8.3) 0.56MAa -4.9 (-10.6 to 1.3) 0.12

Abbreviations: MA=Medicare Advantage. aReference group=Commercial health plan.

Supplemental Table 4. Unadjusted and Adjusted Differential Changes in Utilization for Outpatient Imaging in the Population-based Payments for Primary Care (3PC) and Non 3PC (Fee-for-Service Comparison) Groups, 2012-2016

3PC Group Non 3PC Group


Post-intervention

, 2016Difference


Post-intervention

, 2016Difference

Unadjusted Differential Change, n

(%)

P-Value

Adjusted Differential Change, %(95% CI)

P-Value AdjustedP-value

Total number of tests by modality per 1,000 patients per year, mean (SD)

CT 110 (646) 114 (759) 5 92 (569) 99 (724) 7 -2 (-2.1) 0.47-6.3

(-11.3 to -1.0)

0.02 0.10

MRI 68 (291) 59 (273) -9 57 (270) 51 (257) -6 -2 (-3.4) 0.09-4.1

(-8.2 to 0.04)

0.05 0.21

Nuclear medicine 33 (203) 23 (176) -10 23 (170) 18 (160) -4 -6 (-17.0) <0.001

-18.1 (-23.8 to

-11.9)<0.001 <0.001

US 296 (966) 324 (976) 28 238 (857) 268 (886) 31 -3 (-1.0) 0.50 -1.9 (-4.6 to 0.9) 0.19 0.37

X-ray 597 (1025) 621 (1076) 24 549 (1005) 570 (1076) 21 3 (0.6) 0.50 -1.0 (-2.5 to 0.5) 0.19 0.37

Other 13 (253) 17 (274) 3 11 (234) 14 (250) 3 1 (4.4) 0.62-15.7

(-31.3 to 3.4)

0.10 0.30

Abbreviations: 3PC=Population-based Payments for Primary Care Intervention; CI=confidence interval; CT=computed tomography; MRI=magnetic resonance imaging; p.p.=percentage point; SD=standard deviation; US=ultrasound.

Supplemental Figure 2. Adjusted Differential Changes in Spending for Outpatient Imaging in the Population-based Payments for Primary Care (3PC) and Non 3PC (Fee-for-Service Comparison) Groups, 2012-2016 – Sensitivity Analysis with Exchangeable Working Correlation Structure


Supplemental Figure 3. Adjusted Differential Changes in Spending for Outpatient Imaging in the Population-based Payments for Primary Care (3PC) and Non 3PC (Fee-for-Service Comparison) Groups, 2012-2016 – Sensitivity Analysis with $0.01 Added to Outcomes


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