Same song, different verse

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 - Evan headshot 2013
Evan Godt, Editorial Director

Stop me if this sounds familiar: a federal agency is scrutinizing the costs and utilization rates of imaging services.

While that sentence could have been a headline from any number of stories in recent years, it also describes one of Health Imaging’s top stories from the past week, in which the HHS Office of Inspector General (OIG) listed three imaging-related audit projects in its Fiscal Year 2015 Work Plan.

Highlighted in a recent statement from the American College of Radiology (ACR), OIG’s plans include auditing Medicare Part B payments for imaging services to review whether payments reflect expenses and an audit of Medicare payments for high-cost diagnostic radiology tests to evaluate medical necessity and any increases in utilization. A third audit focuses on hospitals’ network security, with radiology systems identified by OIG as a potential problem area where medical devices may jeopardize privacy, though this investigation isn’t focused on imaging utilization.

The fact that two of OIG’s investigative targets involve costs and utilization of imaging is more evidence that the value-over-volume mantra has taken hold. Even as imaging utilization growth has plateaued and dipped from its peak in the 2000s, imaging services will continue to face scrutiny.

Researchers in the radiology community have taken this message about utilization to heart, and another top story this week features a study into the diagnostic yields of CT for dizziness or fainting in the ED. Myles M. Mitsunaga, MD, of the John A. Burns School of Medicine at the University of Honolulu, and Hyo-Chun Yoon, MD, of the Kaiser Foundation Hospital in Honolulu, looked at nearly 500 patients seen in the ED for dizziness or fainting who also underwent a head CT scan. Results published online in the American Journal of Roentgenology showed that only 7.1 percent of patients with dizziness and 6.4 percent of those who fainted or were near fainting had acutely abnormal head CT findings.

The authors noted that emergency physicians may rely on CT despite low diagnostic yields in an effort to quickly screen a patient, though head CT should be used more as a diagnostic test and not a screening exam.

“Our results suggest that most patients presenting with syncope or dizziness to the emergency department may not benefit from head CT unless they are older, have a focal neurologic deficit, or have a history of recent head trauma,” Mitsunaga and Yoon wrote.

While the pressure may be on to rein in costs and unnecessary utilization, the radiology community appears up to the task.

-Evan Godt
Editor – Health Imaging