Radiology experts recommend ‘expenditure mapping’ as path to addressing rising imaging costs

Radiology experts are recommending the use of “expenditure mapping” to address rising costs in medical imaging.

UNC Health undertook this exercise with a focus on pediatric diagnostics, according to a study published in Current Problems in Diagnostic Radiology [1]. Lead investigator Danika Baskar, MD, did so by analyzing claims from a single value-based commercial insurance plan, which covers fee-for-service payments, quality goals and potential shared savings.

They found that children covered by the plan were more medically complex than UNC had anticipated, amassing nearly $3 million in imaging expenditures in one year. Baskar et al. also determined that focusing cost-reduction initiatives on certain conditions and a small number of imaging users was likely to produce the biggest gains.

“As organizations focus on cost reduction, we propose the concept of expense mapping based on claims data as a mechanism to better understand where the largest healthcare costs exist in caring for a specific population. This knowledge may help guide planning and prioritization of cost reduction initiatives,” Baskar, a UNC diagnostic radiology research fellow at the time of the study, and co-authors wrote July 18.

For the analysis, experts analyzed claims data for members covered by the value-based exchange product in 2022. Under the health plan, inpatient admissions are billed as a cumulative sum payment, with the authors forced to focus solely on outpatient and emergency department imaging claims. Baskar and colleagues segregated imaging expenditures from claims data using different “resource utilization bands” and conditions to create their expenditure map.

Bands ranged from 0 for “nonusers” to 5 for “very high morbidity.” The analysis unearthed a total of 40,022 pediatric plan members treated in a single year at UNC. Of those, 14% had imaging-related claims accounting for about $2.8 million in expenditures or $69 per member per year. Patients in resource-utilization category 3 (“moderate morbidity”) had the largest total imaging costs at nearly $1.2 million. That’s more than double the total annual imaging spending on patients in higher-morbidity category 5 ($447,392).

“These insights changed our understanding of costs related to imaging in this pediatric population,” the authors noted. “The children in this plan were more medically complex than we had anticipated, likely related to selection bias in that families of children with medical conditions were probably more likely to select this plan via the healthcare exchange than families with healthy children.”

 The top three diagnoses with the highest total imaging costs were developmental disorders ($443,980), asthma ($388,787) and congenital heart disease ($294,977). Meanwhile, the highest per-member, per-year imaging expenditures were tied to malignancy/leukemia ($3,100), transplants ($2,639) and tracheostomy ($1,661).

“These diagnostic groups may be prime targets for cost reduction, especially if expenses related to imaging studies performed may be influenced,” Baskar and co-authors urged. “This information can inform further cost reduction initiatives through a patient diagnosis-informed approach. We have used expenditure mapping to choose pilots for cost reduction efforts for children with chronic complex conditions in the areas of asthma and developmental disabilities as well as looking at the pockets of expenditures in those groups to choose areas of cost reduction targets,” they added later.

Read more in CPDR at the link below.