Imag­ing trans­parency

Us­age, reporting re­quire­ments are hot top­ics

Modern Healthcare - - THE WEEK IN HEALTHCARE - Jaimy Lee

With med­i­cal imag­ing re­im­burse­ment and use de­clin­ing in the U.S., ra­di­ol­o­gists are in­creas­ingly forced to ar­tic­u­late the value of imag­ing ser­vices. Dur­ing the Ra­di­o­log­i­cal So­ci­ety of North Amer­ica’s an­nual meet­ing last week in Chicago, the au­thors of a new sel­f­re­fer­ral study said that re­duc­ing un­nec­es­sary imag­ing ex­ams would bet­ter serve pa­tients and the broader health­care sys­tem. Fur­ther re­duc­tions in imag­ing re­im­burse­ment would only limit ac­cess, they say.

“There are a lim­ited num­ber of health­care dol­lars and we need to spend them as wisely as pos­si­ble,” says Dr. Ben Pax­ton, ra­di­ol­ogy res­i­dent at Duke Univer­sity Med­i­cal Cen­ter and a coau­thor of the un­pub­lished study.

Pax­ton and Dr. Ram­sey Ki­lani, a se­nior author of the study, also said they sup­port stricter reporting re­quire­ments, in­clud­ing the pos­si­bil­ity of leg­is­la­tion, that would re­quire in­creased trans­parency around the own­er­ship of imag­ing equip­ment and the ap­pro­pri­ate­ness of its use.

Con­cern about the tie be­tween spend­ing on imag­ing and the fi­nan­cial in­ter­est of physi­cians’ of­fices prompted the Govern­ment Ac­count­abil­ity Of­fice in 2008 to ques­tion “whether Medi­care’s physi­cian pay­ment poli­cies em­body fi­nan­cial in­cen­tives for physi­cians to overuse imag­ing ser­vices.”

The self-re­fer­ral study found that or­tho­pe­dic physi­cians who own or lease MRI equip­ment are more likely to re­fer pa­tients for scans that may be un­nec­es­sary. The re­searchers looked at 500 con­sec­u­tive di­ag­nos­tic lum­bar spine MRI ex­ams or­dered by two or­tho­pe­dic physi­cian groups in a large met­ro­pol­i­tan city on the East Coast. Forty-two per­cent of the pa­tients who had ex­ams at the group with a fi­nan­cial in­ter­est in the MRI equip­ment had neg­a­tive scans, com­pared with 23% of pa­tients whose scans were or­dered by the group with no fi­nan­cial in­ter­est. There was no sig­nif­i­cant dif­fer­ence be­tween the groups in the num­ber of ab­nor­mal­i­ties in pos­i­tive scans.

An in­creas­ing num­ber of non-ra­di­ol­o­gists own or lease MRI equip­ment even as re­im­burse­ment for imag­ing ser­vices has de­clined. The num­ber of MRI scans per­formed by non­ra­di­ol­o­gists who ei­ther own or lease the equip­ment in­creased by 254% from 2000 to 2005, com­pared to the 83% growth rate for ra­di­ol­o­gists, ac­cord­ing to a 2008 study in the Jour­nal of the Amer­i­can Col­lege of Ra­di­ol­ogy. Or­tho­pe­dic sur­geons were the most ac­tive in or­der­ing MRI ex­ams among non-ra­di­ol­o­gists. In 2005, they per­formed 161,296 Medi­care ex­ams billed to Medi­care, more than twice as of­ten as the neu­rol­o­gists (63,363 Medi­care ex­ams), the spe­cial­ists next most in­clined to or­der MRIS.

The Deficit Re­duc­tion Act im­ple­mented re­im­burse­ment re­duc­tions for imag­ing ser­vices in 2006, which led to a drop in imag­ing spend­ing for Medi­care ben­e­fi­cia­ries. An anal­y­sis of Medi­care data re­leased by the Med­i­cal Imag­ing and Tech­nol­ogy Al­liance last month found that Medi­care spend­ing on imag­ing for each ben­e­fi­ciary fell 13.2% from 2006 to 2010. The al­liance said that Medi­care re­im­burse­ments for imag­ing pro­ce­dures have been cut six additional times since the Deficit Re­duc­tion Act.

“The is­sue now is one of ac­cess to imag­ing and over­all costs to the sys­tem,” Ki­lani said dur­ing the RSNA news con­fer­ence.

At­ten­dance at RSNA was up about 2% com­pared with last year, with about 58,000 at­tend­ing the Chicago gath­er­ing.

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