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AMIC Says JAMA Imaging Study Affirms Recent Decline In Imaging Utilization

Appropriate Use of Imaging Saves Lives, Is Not Driving

The Access to Coalition (AMIC) said that research (Smith-Bindman et al.) published today in the Journal of the American Medical Association () validates government and independent analyses showing that medical has fallen in recent years among both Medicare and privately-insured individuals.

for medical imaging services have been cut repeatedly since 2006, many by more than half. A November 2011 independent analysis of Medicare data showed that per-beneficiary imaging spending has dropped 13.2% since 2006, and imaging utilization per beneficiary fell 3% in 2010 alone. Meanwhile, spending for non-imaging services has grown 20% since 2006 and utilization increased 2% in 2010. These Medicare trends have been confirmed by the Medicare Payment Advisory Commission (MedPAC), while a recent report by the Health Care Cost Institute revealed that imaging is the slowest growing of all physician services among privately insured individuals.

“Smith-Bindman’s team found similar trends in imaging use, again confirming that the utilization curve has reversed since 2006. The cumulative effect of continued cuts to imaging reimbursement is reduced access to mammograms, bone density scans and other critical diagnostic services, which will increase health care costs over the long term,” said Tim Trysla, executive director of AMIC.

In December 2011, Health Affairs published a study showing that cuts to Medicare payments for bone density scans led to the performance of 800,000 fewer tests than expected (based on historic trends) – tests that could have contributed to the prevention of 12,000 fractures. An 11-year trend analysis by The Moran Company found declines in mammography and bone density scans, which are recommended screening services for Medicare beneficiaries but whose total Medicare volume fell by 0.3 and 2.2 percent respectively in 2009.

These trends are occurring at a time when research continues to underscore the tremendous value of imaging in improving outcomes and reducing costs. A recent study published in JAMA showed the addition of screening ultrasound or magnetic resonance imaging (MRI) to mammography in women resulted in a higher breast cancer detection among women at increased risk for the disease. Numerous studies show that medical imaging is directly linked to greater life expectancy, declines in mortality rates, and are generally safer and less expensive than the invasive procedures that they replace. Scans also reduce the number of invasive surgeries, unnecessary hospital admissions and length of hospital stays.

“Right scan, right time policies like widespread adoption of physician-developed appropriateness criteria and mandatory accreditation for imaging facilities are the way to ensure patients’ access to diagnostic and screening services while encouraging the proper use of medical imaging,” said Trysla. “They also improve health outcomes, reduce hospital stays and save money in the longer run.”

AMIC supports mandatory accreditation for imaging facilities and the widespread adoption of physician-developed appropriateness criteria, which guide physicians’ provision of imaging and radiation services without limiting their professional judgment or placing barriers between patients and necessary care. When used in combination with clinical decision support software to assist physicians in determining when to perform medical imaging and which modality to use, appropriateness criteria have proven effective in reducing unnecessary tests. A 2009 study found that decision support software helped to generate marked decreases in CT, MRI, and ultrasound utilization growth.

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Source: Access to