More on reining in medical imaging costs in health care reform

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Radiologist Pat Basu of Stanford has an important column on the Kaiser Health News Service, "Medical Imaging: The Good, The Bad and The Ugly."

Excerpts:

As a radiologist, I know first-hand how medical imaging--e.g. MRIs and CT scans-- has both revolutionized medicine and increased costs. In its current state, diagnostic imaging can be seen as "The Good, The Bad and The Ugly". Congress must separate healthy and unhealthy growth - promoting the benefits while curing malignant growth in imaging through a bill that protects patient access, realigns physician incentives and reduces excessive use. ...


However, despite all of its benefits, we haven't optimized the use of imaging. Too many unnecessary or repeat exams are performed; inappropriate utilization that forms the "bad" in the trio. The reasons for this inappropriate imaging include patient demands, fear of medical malpractice, lack of knowledge about when to use imaging, and incomplete clinical examinations prior to requesting an imaging study.

Unfortunately, when imaging is ordered without appropriate clinical work-up, it can lead to more questions than answers. Even though medical imaging is generally an extremely safe technology, inappropriate imaging creates significant direct and indirect economic costs. For example, a single unwarranted MRI can occupy an hour of scanner time and an hour of a radiologist's time, preventing or delaying access for patients who truly need it. ...


But medical imaging is not simply hampered by well-intentioned over-prescription. The ugly truth is the rapidly increasing problem of intentionally referring patients to doctors' self-owned imaging scanners for personal profit - a practice known as self-referral. Most patients are unaware of this and shocked that this is even legal. ...


Congress must act swiftly to halt this expensive, inappropriate imaging. This can be achieved by mandating that imaging meets nationally standardized appropriateness criteria. Such guidelines are readily available. In fact, a bill passed in 2008 took a first step in this direction. An amendment to one of the health care overhaul bills being considered by Congress, The Integrity in Medicare Advanced Diagnostic Imaging Act, attempts to halt ugly self-referral practices by closing the aforementioned loophole.

The few who have used self-referral as a golden goose have jeopardized the benefits of imaging by bringing them under the notoriously blunt scalpel of Congress. As in the wider healthcare debate, imaging requires better research, realignment of incentives and reduction of unnecessary spending. Instead of across-the-board cuts or maintaining the status quo, a thorough, explicit bill can curb these inappropriate, unethical and costly sides of medical imaging.

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Closing the regulatory loophole that allows referring physicians to profit from imaging performed on office-based MRI and CT equipment they own would save millions of wasted healthcare dollars. As Dr. Basu notes, tort reform would eliminate imaging performed as a costly hedge against future malpractice claims. Other imaging experts recommend mandatory participation in imaging equipment accreditation programs that certify equipment quality and physician competence. Clinical appropriateness criteria can be integrated into image ordering systems, so referring MDs are briefed about recommended protocols to help them order the most effective procedure.

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This page contains a single entry by Gary Schwitzer published on August 13, 2009 9:52 AM.

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