Inappropriate imaging: How research helps to combat the threat

Research published within the last week illustrates that there clearly is a ways to go to ensure that the problem of inappropriate imaging is being adequately addressed.

One study, out of the Mayo Clinic and published in BMJ, suggests that the availability of advanced imaging technologies such as CT, MRI and ultrasound, and their zealous use by physicians, has resulted in overdiagnosis and overtreatment of low-risk thyroid cancers.

Another study, published in the American Journal of Roentgenology, illustrates the potential problems associated with self-referrals. This study found that physician groups that own their own MRI scanners are more like to order tests that end up being negative, than physicians who don't own scanners.

As we have learned, the consequences of inappropriate imaging are significant. For one thing, the costs in healthcare dollars are substantial. A report published last fall by the Government Accountability Office, for example, determined that inappropriate self-referrals in the Medicare Program in 2010 cost the program $100 million.

Then there are the risks associated with inappropriate imaging, such as increased cancer risks from undergoing CT scans. There's also the problem of  increasing patient anxiety by putting them through tests unnecessarily.

So what should be done?

For starters, getting rid of the ancillary services exception to the Stark Law for advanced imaging, radiation therapy and other services would be an important step, although that's easier said than done. A bill introduced in congress last month--the "Promoting Integrity in Medicare Act of 2013"--looks to do just that, though. While there is no guarantee that congress will act on it--similar legislation died in committee in 2011--the fact that President Obama called for the elimination of the Stark Law exception in his 2014 budget proposal suggests pressure is increasing to do something on that front.

It also would be helpful if more attention were paid to the subject in medical school. Research presented at the Radiological Society of North America's annual conference in Chicago last November showed that appropriate imaging utilization ranked a distant second in importance behind image interpretation, and that barriers like lack of faculty time prevented more emphasis from being placed on appropriate imaging.

While unnecessary imaging will never entirely disappear, studies like the aforementioned two published within the last week go a long way toward ensuring that the issue doesn't fade away, either. Considering the financial and safety stakes, I hope to see more of the same in the near future. - Mike  @FierceHealthIT

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