Imaging utilization regional variation lower than other major services

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Regional variation in the utilization of imaging was discovered to be considerably less than regional variation in standardized costs and  the variation in use of other major service categories for Medicare beneficiaries from 2007 to 2011, according to a study published in the January 2014 issue of the Journal of the American College of Radiology.

Once the Patient Protection and Affordable Care Act (PPCA) was passed in 2010, the Institute of Medicine (IOM) created the Committee on Geographic Variation in Health Care Spending and Promotion of High-Value Care to investigate factors behind geographic variation in the utilization, costs, and quality of health care services. These findings would then aid in the formation of recommendations for Medicare payment reforms that embrace high-value care.

“The IOM’s data regarding regional variation in imaging is of particular note given that shortly before the passage of PPACA in 2008, Congress had requested that the US Government Accountability Office (GAO) provide data and commentary relating to the drastic rise in Medicare spending for imaging services,” wrote the study’s author, Andrew B. Rosenkrantz, MD, of the New York University Langone Medical Center in New York City.

Rosenkrantz thus evaluated trends in regional variation in utilization and expenditures for imaging services in the Medicare population from 2007 to 2011 and compared the trends with regional variation of other health service categories in light of the concerns about the substantial regional variation in imaging expenditures.

From 2007 to 2011 imaging costs per beneficiary standardized for regional differences in reimbursement rates and imaging utilization per beneficiary were recorded in the Center of Medicare and Medicaid’s (CMS) Chronic Condition Data Warehouse. These data were organized on the basis of 306 U.S. health referral regions (HRRs). In 2011, Costs and utilization were recorded for other service categories. Statistical analysis demonstrated the regional variation as well as correlations between imaging and other service categories.

The study’s results revealed that a minimal change occurred in regional variation in imaging costs and utilization between 2007 and 2011. However, regional variation in imaging costs was significantly greater than variation in imaging utilization. Imaging costs and utilization exhibited moderate to strong correlations with other service categories. In the study’s final year, regional variation in imaging utilization was considerably lower than variation in the utilization of other service categories.

“Given these observations, it is unclear whether regional variation in the utilization of imaging provides an optimal individual target for major policy decisions. Future studies are warranted to investigate the impact of regional variation in imaging utilization and costs, as well as any federal reform efforts that target such variation, on the quality of care and health outcomes,” wrote Rosenkrantz.