In the US, utilization of CT and MRI scanning increased 43% between 2002 and 2007 to 96 million procedures. PET scanning tripled over the same period.
Americans did not get sicker during this time, nor had the medical community been inundated with evidence suggesting the tests were underutilized beforehand. In fact before the most recent imaging fiesta began, experts had estimated that 30% of all scans were unnecessary.
The drivers of inappropriate scanning haven’t changed in 30 years. Patients want the reassurance. Physicians want protection from litigation and sometimes, physicians benefit financially from the tests they order.
This state of affairs is unacceptable for two reasons. First, the scans can cause harm, either by direct radiation exposure in the case of CT, or by obligating risky invasive interventions to track down false positive results. Second, imaging tests are expensive. It costs $228 dollars for a CT scan, $977 for an MRI and $2,000 for a PET.
Health care providers see themselves as guardians of the quality of care, but for the most part their efforts to do so are patchwork and ineffective. There are some guidelines, an occasional implementation strategy, a performance measurement system or two, and a rare link between pay and performance, but the whole thing doesn’t add up as the above statistics suggest.
Yet they howl like coyotes when payers hire radiology benefits managers, known lovingly in the industry as Radiology Police, to oversee the matter. No less than three such organizations, CareCore National, American Imaging Management and National Imaging Associates turn a profit doing just that.
Those profits are a measure of waste in the US health care system.
The situation begs for providers to take ownership of the situation, and now for the first time they have the tools to do so. Plenty of good guidelines are available and EMR systems that support real time, guidelines-based quality checks give providers an unprecedented opportunity. We can do this, guys!