Will decreased imaging spending result in an explosion in downstream costs?

Researchers tallied a 21 percent drop in imaging spending since 2006 and observed a 6 percent increase in hospital length of stay during the same time frame. The finding suggests that every dollar saved on imaging might translate into an additional unnecessary three dollars in downstream costs, according to an American College of Radiology think tank.

The Harvey L. Neiman Health Care Policy Institute released its inaugural report “Medical Imaging: Is the Growth Boom Over?” Oct. 23. The report detailed a nearly 5 percent decrease in imaging use since 2006 and a 21 percent reduction in spending.

Richard Duszak, MD, CEO and senior research fellow of the institute, characterized the perception of imaging as a primary driver of healthcare costs as an outdated myth.

Duszak attributed falling use and spending to several factors. These include:

  • Seven cuts in Medicare funding, totaling $6 billion, since 2006;
  • Promulgation and use of evidence-based guidelines;
  • Improved radiation awareness and education efforts such as Image Gently and Image Wisely;
  • Enhanced access to electronic health records, which helps curb unnecessary repeat imaging;
  • Technology maturation and market saturation; and
  • Increasing use of radiology benefits managers and clinical decision support systems.

In addition to detailing the drop and reviewing its causes, the researchers considered related outcomes and noted the drop may portend troubling trends in patient quality and safety. “Coincident with recent national declines in the utilization of medical imaging, for example, average patient hospital length of stay has increased,” the report read. The average length of stay increased from 4.9 days to 5.2 days.

The added cost of the increase could reach $17 billion to $21 billion, Duszak said in a webinar. Researchers do not know the true costs of the length of stay increase, related imaging costs or other contributory factors, Duszak admitted.

However, he added, “If future research demonstrates causation rather than mere association this would mean that for every dollar saved, the healthcare system may actually unnecessarily spend another three dollars downstream.”

Previous peer-reviewed studies also have hinted at a link between imaging and hospital admissions and hospital stay. For example, among low-to-intermediate risk patients who presented to the emergency department with possible acute coronary syndrome, patients who underwent coronary CT angiography had a higher rate of discharge from the emergency room, a shorter length of stay and a higher rate of detection of coronary disease, compared with those who received traditional care, according to a study published April 12 in the New England Journal of Medicine.

Similarly, a study published in Journal of American College of Radiology in April 2010 reported that early imaging with CT, MRI, or nuclear scintigraphy, particularly on the day before or the day of admission, was associated with significantly shorter lengths of stay of inpatients compared with patients who underwent advanced imaging later.

“With imaging utilization declining, it is possible that these beneficial trends associated with imaging could be reversing,” according to the institute. The current findings might represent the tip of an iceberg, with a host of detrimental quality, safety and costs issues lurking below the surface, Duszak continued.

“These associations need to be closely examined,” Duszak said, and then offered a preview of upcoming items on the institute’s research agenda. These include associations between imaging and downstream morbidity, mortality, length of stay and costs as well as analysis of modality-specific data.

The ultimate goals of the institute include providing policy makers and payers accurate data rather than dated information for decision making, he said.