In-office imaging drives imaging growth; study cites safety concerns

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Health plans are stepping up efforts to slow the proliferation of advanced imaging services due to growing concerns about patient safety and quality of care related to rapid increases in MRI, CTs, PET scans and nuclear cardiology imaging for in-office imaging, according to a study released by the Center for Studying Health System Change (HSC).

The HSC study details the rapid growth in imaging utilization, particularly in-office imaging, and various steps that private and public payors are taking or may take to address the issue.

In particular, it cites double-digit increases annually in CT and MRI scans and attributes much of the growth to poor quality, duplicative exams performed in physicians' offices. “Repeated imaging may result from poor quality images generated by substandard equipment or from inaccurate interpretation of results by inadequately trained physicians,” the report stated.

"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, PhD, president of HSC, a nonpartisan policy research organization funded in part by the Robert Wood Johnson Foundation.

The study highlights safety concerns associated with poorly trained imaging providers and the need for quality standards for medical imaging provided under the Medicare system. "MedPAC [Medicare Payment Advisory Commission] recommended that CMS set standards for physicians who bill Medicare for performing and interpreting diagnostic imaging studies, citing the need to control Medicare spending and enhance the quality of care,” according to the study.

It does, however, mention ACR’s efforts to reduce radiation dose estimates from CT scans and other modalities which use ionizing radiation, and its efforts to educate referring physicians regarding safe, necessary imaging.

The study's findings are detailed in a new HSC Issue Brief— Health Plans Target Advanced Imaging Services: Cost, Quality and Safety Concerns Prompt Renewed Oversight—available online at