A different story on utilization

For some time, studies of medical imaging use revealed skyrocketing utilization starting around the turn of the millennium. This invigorated efforts to control usage rates, mostly by way of trimming reimbursement.

The story is now shifted, with the narrative du jour being that imaging use did rise precipitously, but in the mid to late 2000s, growth in utilization plateaued and is now in a period of decline.

But even as this version of events has barely had a chance to take hold in the public and professional consciousness, a fascinating new study published in the July issue of the Journal of the American College of Radiology has shown that a downward shift in imaging use began even earlier, from at least 2003.

Researchers from the Harvey L. Neiman Health Policy Institute in Reston, Va., decided to look at the proportion of medical encounters that resulted in imaging, rather than the traditional method of examining overall imaging rates or spending. They found that 12.8 percent of encounters led to imaging in 2003, with a consistent downward trend to 2011 when only 10.6 percent of encounters resulted in a scan of some kind.

Even though radiology is no longer in a panic state over rampant utilization, ensuring appropriate use and controlling costs looks to remain a focus for the foreseeable future, and this week we covered a couple novel approaches to this end. A study in the July issue of the American Journal of Roentgenology showed that a two-tiered strategy for MRI use could yield big savings when dealing with patients presenting with headache. By using an abbreviated MRI scan initially, and sending only the patients who seem to have abnormalities for a comprehensive scan, costs to payers can be cut 40 percent and reimbursement rate per minute of scanner utilization can increase. Cardinal Health in Dublin, Ohio, offered another method of reducing spending by leveraging an oncology pathways program to encourage cost-effective management, saving $8 million in the process.

What has been your utilization narrative and how are you working to encourage appropriate use? We’d love to hear.

Evan Godt
Senior Staff Writer