Link between imaging decline, hospital stays merits investigation

Imaging and radiology groups have long argued that medical imaging policy decisions--such as Medicare reimbursement cuts--have had a deleterious effect on patient care by reducing access to imaging.

Last month, for example, the Medical Imaging & Technology Alliance released an analysis that showed that imaging utilization per Medicare beneficiary has declined by 5.1 percent since 2009. Now, a report by the American College of Radiology's Harvey L. Neiman Health Policy Institute suggests that the decline in the delivery of imaging scans could result in lengthier hospital stays and increased costs associated with that trend.

HPI isn't the first to suggest that there's a connection between access to medical imaging and length of hospital stays. An article in the April issue of the New England Journal of Medicine found that the use of coronary computed tomographic angiography (CCTA) for low- to intermediate-risk patients arriving at emergency departments with chest pain resulted in fewer hospital admissions and shorter stays. And a study published in the April issue of the Journal of the American College of Radiology found that the early use of imaging with MRI, CT or nuclear scintigraphy reduced the length of hospital stay.

As HPI CEO Richard Duszak points out, if this relationship between longer hospital stays and imaging decline is accurate, it represents an unfortunate paradox. Surely, when healthcare policymakers went about implementing imaging cost-reduction policies, they weren't intending to increase hospital stays and, correspondingly, to increase costs.

Yet, that could be the case. The HPI report, using information gathered from the Medical Expenditure Panel Survey, found that medical visits involving imaging declined from 11.1 percent in 2000 to 10.4 percent in 2010. At the same time, the average length of a Medicare hospital stay increased from 4.9 to 5.2 nights.

An average increase of 0.3 nights per hospital stay may not seem much--but according to HPI it could represent as much as $21 billion in added healthcare costs.

It isn't exactly clear whether the increased hospital stay and imaging services decline trends are related. But, if it is at all possible that government and private insurance imaging reductions are achieving precisely the opposite of what they're supposed to accomplish--never mind the ongoing argument about the impact on patient care--then this is surely an issue that merits investigation. - Mike

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