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Rapid Growth Prompts Health Plans to Target Advanced Imaging Services
Cost, Quality and Safety Concerns Prompt Renewed Oversight
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Along with escalating cost pressures resulting from the rapid growth in imaging utilization, there also are growing concerns about patient safety and quality of care related to rapid increases in magnetic resonance imaging (MRI), computed tomography (CT) scans, positron emission tomography (PET) scans and nuclear cardiology imaging.
For example, according to a 2007 McKinsey and Co. analysis, the number of CT scans performed in the United States grew 13 percent annually between 2000 and 2005, rising from 12 CT scans per 100 people in 2000 to 22 scans per 100 people in 2005.
Repeated imaging may result from poor quality images generated by substandard equipment or from inaccurate interpretation of results by inadequately trained physicians. Regardless, repeated use of CT scans, for example, can expose patients to excessive amounts of radiation, because these scans generally emit significantly larger amounts of radiation than traditional X-rays.
"Health plans are targeting selected, high-cost services, such as advanced imaging, for more aggressive oversight rather than imposing stricter controls across all services, hoping a targeted approach will help avoid physician and patient backlash against perceived intrusion on physician autonomy," said Paul B. Ginsburg, Ph.D., president of HSC, a nonpartisan policy research organization funded in part by the Robert Wood Johnson Foundation (RWJF).
Plan strategies range from informing physicians about evidence-based imaging guidelines to requiring prior authorization of services to credentialing physicians and imaging equipment. Mindful of the physician backlash against managed care in the 1990s, plans are instituting requirements they perceive to be less intrusive and burdensome for physicians. Some physicians, however, view the requirements as administratively onerous and obstacles to patient care, according to the study.
"Despite physician objections, health plans generally have stood firm because they believe the cost savings and patient safety gains outweigh the negatives," said HSC Health Researcher Ann Tynan, M.P.H., coauthor of the study with HSC senior consulting researchers Robert A. Berenson, M.D., of the Urban Institute, and Jon Christianson, Ph.D., of the University of Minnesota.
The studys findings are detailed in a new HSC Issue BriefHealth Plans Target Advanced Imaging Services: Cost, Quality and Safety Concerns Prompt Renewed Oversightavailable online at www.hschange.org/CONTENT/968. The study, funded by RWJF, is based on HSCs 2007 site visits to 12 nationally representative metropolitan communities: Boston; Cleveland; Greenville, S.C.; Indianapolis; Lansing, Mich.; Little Rock, Ark.; Miami; northern New Jersey; Orange County, Calif.; Phoenix; Seattle; and Syracuse, N.Y. HSC has been tracking change in these markets since 1996.
Other key study findings include:
The Center for Studying Health System Change is a nonpartisan policy research organization committed to providing objective and timely research on the nations changing health system to help inform policy makers and contribute to better health care policy. HSC, based in Washington, D.C., is funded principally by the Robert Wood Johnson Foundation and is affiliated with Mathematica Policy Research, Inc.