What’s wrong with this pic­ture?

It’s time to get se­ri­ous about the over­con­sump­tion of health­care ser­vices

Modern Healthcare - - Opinions Editorials - DAVID MAY As­sis­tant Man­ag­ing Edi­tor/Fea­tures

Are we the pic­ture of health? Or does the im­age spell bad news? It’s a de­ter­mi­na­tion doc­tors can now make faster than ever.

We’re talk­ing, of course, about med­i­cal imag­ing and the ad­vance­ments the field has brought to the prac­tice of medicine over the years. It’s truly a health­care suc­cess story, given the myr­iad im­prove­ments in di­ag­noses and treat­ment thanks to rev­o­lu­tion­ary tech­nolo­gies.

At the same time, how­ever, imag­ing rep­re­sents a chronic mal­ady in the health­care de­liv­ery sys­tem and in our so­ci­ety in gen­eral: We con­sume too much of a good thing.

Just last week, Chicago again hosted the an­nual gath­er­ing of the Ra­di­o­log­i­cal So­ci­ety of North Amer­ica, one of the largest mem­ber­ship groups rep­re­sent­ing the med­i­cal imag­ing sec­tor. The sprawl­ing con­fer­ence and technology expo drew nearly 60,000 at­ten­dees and some 700 ven­dors. The event al­ways touts the lat­est ad­vances and re­search in ra­di­ol­ogy.

This year’s meet­ing in­cluded a panel dis­cus­sion that ad­dressed safety is­sues in med­i­cal imag­ing, as well as the costly and po­ten­tially harm­ful prob­lem of overuti­liza­tion.

“Imag­ing pro­ce­dures con­ducted for the wrong rea­sons con­trib­ute to un­nec­es­sary costs and ra­di­a­tion ex­po­sure to pa­tients,” said Wil­liam Hendee, a pro­fes­sor of ra­di­ol­ogy at the Med­i­cal Col­lege of Wis­con­sin, Mil­wau­kee, and one of the ses­sion’s pan­elists, in a news re­lease.

Se­ri­ous over­ex­po­sure to ra­di­a­tion as a re­sult of imag­ing tests—typ­i­cally be­cause of hu­man er­ror—made head­lines this year and prompted a rush to im­ple­ment a va­ri­ety of re­me­di­a­tion mea­sures. These were alarm­ing in­ci­dents, pro­ce­dures po­ten­tially re­sult­ing in more harm than good, which is an­ti­thet­i­cal to any def­i­ni­tion of qual­ity med­i­cal care. Even the best technology can quickly lose its luster if there isn’t a rea­son­able guar­an­tee of pa­tient safety.

Last week also brought a re­port in the jour­nal Ra­di­ol­ogy on the use of CT scans in the nation’s emer­gency de­part­ments—find­ings that again raise ques­tions about the overuse of imag­ing ser­vices.

Re­searchers us­ing data from a Cen­ters for Dis­ease Con­trol and Pre­ven­tion na­tional sur­vey found a 500% in­crease in the num­ber of ED vis­its that in­cluded the use of CT from 1995 to 2007—surg­ing from 2.7 mil­lion to 16.2 mil­lion dur­ing that pe­riod. At the same time, the use of tests re­quir­ing higher doses of ra­di­a­tion rose at a faster rate than pro­ce­dures re­quir­ing lower ra­di­a­tion lev­els.

While the re­port’s au­thors ac­knowl­edged that the study did not di­rectly ad­dress the is­sue of med­i­cal ap­pro­pri­ate­ness, “the in­creas­ing use of CT in the EDs through­out the United States raises the ques­tion of whether CT use rates are mov­ing to­ward ap­pro­pri­ate rates or have moved be­yond them.”

While there’s no dis­put­ing the fact that ad­vances in technology, along with in­no­va­tions in pharma and other med­i­cal break­throughs, can be cred­ited with im­prov­ing health and sav­ing lives, what about the big pic­ture? Re­cent stud­ies con­tinue to show that we’re still a coun­try that spends much more per capita than other na­tions, yet we still end up sev­eral rungs lower when it comes to qual­ity, safety, ac­cess and over­all out­comes. It ap­pears that state-of-the-art di­ag­nos­tic tools can take us only so far.

As we’ve pre­vi­ously dis­cussed at length on this page, the nation needs to make a much stronger com­mit­ment when it comes to get­ting the health­care cost spi­ral un­der con­trol. If we look at the long-term trends, it’s more like we’ve been fight­ing a health­care cost cy­clone. We con­tinue to use too many health­care ser­vices for all the wrong rea­sons.

It’s cer­tainly not too early for providers and con­sumers to make a New Year’s res­o­lu­tion promis­ing to take our health­care di­et­ing much more se­ri­ously.

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