Private insurers struggle to contain imaging use, associated costs

The use of diagnostic imaging covered by private insurers started falling in 2009, but quickly picked up again for most modalities, according to a study published online in the Journal of the American College of Radiology.

While there has been much research on imaging utilization trends in the Medicare population, researchers led by Michal Horný of the Boston University School of Public Health decided to see whether similar trends were to be found among the privately-insured population.

The researchers, using data from a claims and encounters database that included almost 29 million people, looked at utilization rates and trends in CT, MRI, PET and ultrasound between 2007 and 2009. They found that for outpatient imaging, utilization rates increased significantly for all four modalities between 2007 and 2009.

Between 2009 and 2010, however, rates fell, with CT and MRI rates dropping below 2007 levels. The average payment per procedure increased between 2007 and 2010, although--as with utilization rates--payments for all four modalities dropped in 2009.

The researchers pointed out that a decrease in payments for the Medicare population occurred in 2007 after the implementation of the Deficit Reduction Act and that it could be possible that providers tried to recover some of those losses by charging more for services for patients with private insurance.

While utilization and payment rates decreased from 2009 to 2010, they picked up again in 2011 for most modalities. Utilization rates increased for CT, MRI and ultrasound, while dropping for PET, while the average payment per procedure increased for each modality.

The imaging use increase in 2011, combined with a "substantial increase" in adjusted payments for all four modalities, the researchers said, should raise concerns about the ability of private insurers to help contain imaging use and its associated costs associated, particularly as millions of Americans move into commercial insurance plans as part of the Affordable Care Act.

Similar recent research also published in JACR showed that while diagnostic CT imaging rates among privately insured patients increased on the whole between 2000 and 2011, the rate of growth slowed after 2009.

To learn more:
- see the study in JACR
- see the study on diagnostic CT imaging rates

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