Advanced imaging for Medicare beneficiaries grew at more than 6 percent a year until 2006, then slowed to 1 to 3 percent a year until 2009, according to a study published at Health Affairs, which also analyzed the reasons and the effects of the slowed growth.
The American College of Radiologists, however, called the study incomplete and potentially misleading.
The authors analyzed claims for Medicare and three commercial insurers, finding that CT use fell for Medicare patients, as did MRI and CT use among privately insured patients.
The deceleration in the market coincided with weaker demand for radiologists, who could command high salaries. The study also cited expansion of prior authorization, increased cost sharing and other policies as contributing to the slowdown.
Imaging of the spine, extremity joints and pelvis, in particular were cited as being previously identified as having unproven medical value.
"What has occurred in the imaging field suggests incentive-based cost-control measures can be a useful complement to comparative effectiveness research when a procedure's ultimate clinical benefit is uncertain," state the authors, David Lee, head of health economics and reimbursement for the United States and Canada for GE Healthcare, and Frank Levy, a professor of urban economics at the Massachusetts Institute of Technology.
The ACR acknowledged that use is down and imaging is among the slowest-growing physician services for privately insured patients. It pointed to greater use of its evidence-based ACR Appropriateness Criteria and greater use of electronic physician order entry systems based on that criteria, which it says have been shown to improve quality, reduce unnecessary scans and lower imaging costs.
It says reimbursement has little to do with doctors' decisions to order scans, and argues that reduced Medicaid reimbursement has had detrimental effects on care, most notably by prompting some imaging centers to close, requiring seniors to commute farther and wait longer for care.
"This Health Affairs study further supports the fact that medical imaging scans are being more efficiently used and are not a primary driver of rising healthcare costs," the ACR statement says.
Indeed, researchers from the University of Tennessee Health Science Center recently published a study showing that use of a health information exchange helped curb repeat imaging tests for headache patients.
A report from vendor IMV's Medical Information Division also found use of CT scans dropping, but not in ERs, which receive higher reimbursement rates. (Commenters on a recent FierceHealthIT post about why consumers should care debate whether that reimbursement discrepancy causes more problems.)
To learn more:
- read the abstract
- hhere's the ACR reaction