Fine tuning imaging utilization

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 - Evan headshot 2013
Evan Godt, Editorial Director

Is that scan really necessary? It’s a question being asked more and more as providers look to give optimal care for their patients by not ordering inappropriate imaging studies—studies that don’t have clinical benefit (and may cause harm) while adding to costs.

Professional associations have begun campaigns, such as “Choosing Wisely,” to educate physicians on best practices, and computerized physician order entry is improving imaging indication quality. Federal policy also plays a major role.

But when thinking about utilization optimization, it’s important to target interventions carefully, and not take too broad a view. A couple of this week’s top stories underscored this very point.

First, a study published online Feb. 5 in Radiology demonstrated the wide regional variation in imaging across the country. Ivan K. Ip, MD, MPH, with Brigham and Women’s Hospital in Boston, and colleagues used a pair of public CMS databases to assess 124 million diagnostic imaging services provided to Medicare beneficiaries in 2012.

Ip and colleagues found CT utilization intensity ranged from 330.4 studies per 1,000 beneficiaries to 684.0. For MRI, the numbers ranged from 105.7 studies per 1,000 to 256.3. They also identified high-impact hospital referral regions, such as Baltimore and Jacksonville, Fla., for CT use, and Dallas and Las Vegas for MRI use.

The authors suggested a targeted approach to managing imaging use would be more effective than broad national interventions. “Although national campaigns and federal policy changes may enable broad system-level improvement, our results suggest that more targeted interventions, focusing on providers that order and/or perform the most common procedures in the highest impact regions, may more efficiently promote needed change,” Ip and team concluded.

Another top-read story from this week that urged caution when trying to control imaging use came from an article published in Neurosurgery. Ammar H. Hawasli, MD, PhD, a neurosurgeon with the Washington University School of Medicine in St. Louis, and colleagues said recommendations against the use of imaging for headaches could have negative outcomes for patients with undiagnosed brain tumors. They presented a retrospective review of patients from their institution, noting that a small number of patients with brain tumors present with headaches as their only symptom, and without neuroimaging these diagnoses could be missed.

“Neurological imaging is a very important part in the assessment of patients with headaches and neurological conditions,” Hawasli told Health Imaging. “Current guidelines are laudable, but may lead to missed diagnoses in patients with brain tumors.”

Providers have come a long way in recent years in terms of ensuring every imaging order is appropriate. As these efforts continue, the above stories are reminders that targeted approaches may trump broader one-size fits all strategies.

-Evan Godt
Editor – Health Imaging