An incidental pulmonary nodule found on CT averages $393 in downstream costs

Incidental pulmonary nodules detected on chest CT cost a downstream average of $393, researchers reported in a new Academic Radiology study. Collaboration may be the key to reducing that number.

Incidental pulmonary nodules are detected in 8.5 percent of chest CTs, according to one study cited by Andrew Rosenkrantz, MD, with NYU School of Medicine, and colleagues. Those patients often undergo multiple follow-up exams, unnecessarily raising expenditures.

“Reduced follow-up testing for incidental pulmonary nodules would not only help to lower patient inconvenience and possible harm, but also lower health care spending,” Rosenkrantz et al. wrote.

Researchers examined 200 patients with an incidental pulmonary nodule detected on chest CT. The downstream events—defined as chest CT, PET/CT, office visits, percutaneous biopsy and wedge resection—were taken from the electronic medical records of those patients.

Using the national Medicare rates, authors calculated the average downstream cost of incidental pulmonary nodules to be $393 per nodule. That number was greater when ordering physicians over-managed radiologist’s recommendations ($940) compared to following guidance ($637) or under-managing ($166).

When comparing the ordering physician’s adherence to the 2017 Fleischner Society Guidelines designed to reduce follow-up exams, those who over-managed cost $860 per nodule. When following those recommendations costs amounted to $292 per nodule compared to $208 when under-managing.

“This differential highlights a critical area of referring physician outreach and education by radiologists to avoid unnecessary costs,” authors wrote. “Further, radiologists could decline performing such follow-up examinations that are not supported by established guidelines if requested by the managing physician.”

Rosenkrantz and colleagues hinted that this could be best accomplished in a capitated payment system in which radiologists are paid on a per-patient basis, rather than a fee-for-service model.

However, authors suggested the best way to reduce these unnecessary follow-up exams and lower costs would involve increased collaboration between radiologists and referring physicians.

“Radiologists may need to assume a greater role in partnering with ordering physicians to ensure appropriate, guideline-adherent, and follow-up testing for incidental findings detected on imaging,” the authors wrote.