Health Care Reform
As dialogue on the most effective strategies for meaningful health care reform continue to play out on a national stage, National Imaging Associates (NIA) remains committed to ensuring patients have access to high-quality, safe and clinically appropriate imaging services.
The Problem: Imaging Utilization Crisis
Our health care system, and Medicare in particular, is in critical condition, threatened by rampant growth of clinically inappropriate services in a number of sectors - most notably within imaging. Consider the following:
- Medicare spending on advanced diagnostic imaging more than doubled from 2000-2006. The costs for CT scans, MRIs and nuclear medicine increased from just under $7 billion in 2000 to more than $14 billion in 2006, growing at a rate of 13% every year.
- As many as one in three advanced imaging procedures paid for by Medicare is clinically inappropriate. What's more, according to the multiple independent studies that resulted in this conclusion, not only were the procedures clinically inappropriate but they did not contribute to a physician's understanding of a patient's condition.
Some argue that passive education, electronic ordering systems and self-monitoring will fix this overutilization. However, these voluntary guidelines have been in place for nearly 15 years, during which time Medicare spending on advanced imaging services has reported continued double-digit annual increases.
This utilization crisis, coupled with the increasing complexities of advanced medical imaging, are the essence of America's imaging challenge. It's a challenge that has a results-oriented solution that ensures patients have access to high-quality, clinically appropriate and affordable care.
The Solution: Management of Advanced Imaging (through Radiology Benefits Management)
As a nation, we need to enact reform strategies with proven track records of success for improved health care quality and affordability. And the answer to this crisis must focus on tried and tested methods that have been proven effective.
Today in the U.S., radiology benefits management programs like the ones available from NIA, utilize a combination of prior authorization with clinical decision support to cover the needs of approximately 90 million Americans. These programs have documented annual expense reductions and related improvements in clinical appropriateness of as much as 10-25%.
This presents a clear solution to the imaging utilization crisis.
However, we also believe that health care decisions should remain in the hands of doctors. That's why our radiology benefits management program is led by doctors and based on physician-developed criteria. By combining the latest in physician-developed, evidence-based criteria with each patient's unique situation, clinical decision support:
- Provides patients with the benefit of an expert second opinion to ensure they receive the right imaging procedure at the right time.
- Optimizes the quality of care, using the latest medical evidence, developed by leading national medical societies, like the American College of Radiology, along with real-time counsel from board-certified radiologists and other specialists.
- Improves the efficiency and effectiveness of advanced imaging by applying the latest technologies and evidence-based criteria for determining the clinical appropriateness of the requested procedure within just three to four minutes in the majority of cases.
The time to address this runaway imaging utilization is now. We can no longer afford to pay for procedures that are medically unnecessary. And, when it comes to reforming high-growth, high-cost areas of health care, like advanced diagnostic imaging, it is crucial that we safeguard access, quality and the clinical value of each and every imaging examination.
Every patient has the right to receive the right scan, in the right place, at the right time. For more information on how NIA is making our voice heard on this important topic, visit our Newsroom. If you would like to partner with us in championing this important topic or would like to learn more about NIA's solutions, contact us.