It’s no secret that the healthcare system in the U.S. has some serious problems, though one of this week’s top stories provides yet another reminder.

Americans are more likely to avoid seeking healthcare because of cost or lack of insurance than a number of their first world peers, according to a study published online Nov. 13 in Health Affairs. In fact, the other 10 countries surveyed for the study—Australia, Canada, France, Germany, the Netherlands, New Zealand, Norway, Sweden, Switzerland, and U.K.—all finished ahead of the U.S. in terms of access to healthcare while also spending significantly less.

It’s hard to take any positives from a last-place finish. There’s no victory, only lessons to be learned. Unfortunately, the lesson from some of the week’s other top stories was that fixing healthcare will prove quite challenging.

Cutting the outrageously high cost of care in the U.S. is a primary goal, and one avenue for bringing down costs would be to limit inappropriate use of imaging. However, a poster presentation at the recent American Heart Association scientific session in Dallas proves this is not so simple.

Brendan R. Malik, MD, of Northeast Ohio Medical School in Rootstown, Ohio, and colleagues assessed a preauthorization program implemented by a large Western Pennsylvania insurance provider designed to reduce the inappropriate use of myocardial perfusion imaging (MPI). From 2010 to 2012, preauthorization cut the percentage of surveyed patients receiving MPI studies from 82.1 percent to 74.6 percent. The resulting shift in use of imaging modalities and compliance costs, however, placed a financial burden on cardiology practices, which reported additional costs of $79,050 per 1,000 patients.

Another study, published online Nov. 18 in JAMA Internal Medicine, demonstrated that American Cancer Society (ACS) guidelines may not be effectively encouraging appropriate breast MRI utilization. Breast MRI is highly sensitive for breast cancer and is recommended for screening or surveillance of high-risk women, though its use among low-risk populations could lead to false positives and unnecessary costs.

Despite these recommendations, the study of a New England-based not-for-profit health plan and multispecialty group medical practice found that only 21 percent of the women receiving screening or surveillance MRIs had evidence of meeting ACS criteria.

Providers can play an important role in reducing inappropriate imaging by implementing technologies such as decision support or streamlining image exchange so that prior studies are more readily available. These smart imaging technologies and more will be on display at the Radiological Society of North America annual meeting in Chicago starting Dec. 1. Follow along with Health Imaging’s coverage to get the latest on imaging innovations, and how radiology could help improve U.S. healthcare.

-Evan Godt
Editor – Health Imaging

egodt@trimedmedia.com