America’s Imaging Challenge
There are a number of factors contributing to
America's imaging challenge - most notably the increasing
complexities of advanced medical imaging, the overuse of diagnostic
imaging tests, growing provider and consumer demand, the
ever-present defensive medicine issue, and escalating health care
costs. All of this adds up to an opportunity to improve the quality
of patient care and have a positive impact on health care spending
for both payors and individual patients. At NIA, we recognize this
opportunity and have developed a full suite of solutions, programs,
and outreach initiatives to address America's imaging problem.
Increasing Complexities
Medical imaging services are a key component of today's health care industry, and utilization continues to grow, outpacing nearly every other health care sector. However complex, NIA recognizes that the dynamic development of imaging technology can contribute to a "perfect storm" of complexity.
These advanced imaging procedures are by far the newest, most complex and most difficult to administer in practice. In addition, our challenge is to match advanced imaging procedures appropriately to each patient's diagnostic needs:
- Magnetic resonance imaging (MRI)
- Magnetic resonance angiography (MRA)
- Functional magnetic resonance imaging (fMRI)
- Magnetic resonance spectrography (MRS)
- Computed tomography (CT)
- Computed tomographic angiography (CTA)
- Nuclear cardiology
- Positron emission tomography (PET)
All too often, the rapid pace of clinical advances and a lack of knowledge on how best to leverage these technologies to appropriately serve the needs of each patient have created barriers to ensuring the most efficient diagnostic pathways and outcomes for the patient. In addition to wide variations in appropriateness, these growing complexities have led to variations in pricing and quality of imaging services.
Concerns About Overuse
Advanced diagnostic imaging can benefit patients when used appropriately - it detects diseases and conditions early and it allows physicians to direct patients to the health care services they need. But, when used inappropriately, advanced imaging provides physicians and patients with minimal clinical benefits, wastes scarce health care resources and can even jeopardize patient safety.
Multiple independent studies have concluded that as many as one-third of all advanced imaging services are either clinically inappropriate or they do not contribute to a physician's diagnosis or the ultimate health outcomes for the patient. This overuse of imaging services poses a risk to patient safety, exposing people to potentially cancer-causing radiation unnecessarily. And, because radiation exposure is cumulative over a person's lifetime, excessive and unnecessary use of advanced imaging is cause for concern.
Here are some examples of overuse:
- A recent NIA study shows that a very large portion of chest CT tests are ordered inappropriately through abusive coding practices. In most cases, 10% to 100% of CTs are ordered with no claims evidence of a previous plain film of the chest. That pattern does not improve with increased use of chest CTs.
- Another recent NIA study shows that a large portion of MRIs are ordered to meet patient demand rather than a true diagnostic need. This is indicated by the fact that 10% to 100% of brain MRIs are ordered without enhancement - a pattern that does not improve even with increased utilization.
Unnecessary Costs
A convergence of factors has contributed to making outpatient imaging one of the most significant contributors to runaway health care costs in the U.S. These factors include:
- Direct-to-consumer marketing
- Manufacturer financing of equipment
- Defensive medicine
- Ease of access to services
Often, traditional technology can be utilized, rather than an advanced imaging procedure, as a more efficient and economical diagnostic tool for physicians. When applying this practice to the one-third of unnecessary advanced imaging tests performed across the nation, this data strongly suggests that efficient radiology benefits management could cut America's radiology expenditures by $20 billion to $30 billion annually.
The end result is a significant reduction in unnecessary health care costs and improved quality of care. To find out more about partnering with NIA to drive better patient outcomes and bottom-line results, contact us.