How radiologists can reduce downstream costs associated with incidental pulmonary nodules
Downstream costs associated with incidental pulmonary nodules are higher when ordering physicians do not adhere to radiologist recommendations or industry guidelines, according to a new study published in Academic Radiology. This gives radiologists yet another opportunity to provide additional value and help cut costs.
The authors examined downstream costs of 200 patients with incidental pulmonary nodules detected on chest CT. Radiologist and ordering physician recommendations were compared to 2017 Fleischner Society Guidelines.
Overall, the average downstream costs associated with an incidental pulmonary nodule was $393 per nodule. When the ordering physician over-managed relative to the radiologist’s recommendations, the average cost was $940. When the physician followed the radiologist’s recommendations, the average cost was $637. The average cost when the physician under-managed the patient’s care was $166.
A similar trend was noted when ordering physicians over-managed relative to the 2017 Fleischner Society Guidelines (an average of $860) and followed the guidelines (an average cost of $292).
“Downstream costs were particularly high in patients in whom the ordering physician over-managed relative to the Fleischner Society guidelines, indicating an opportunity to reduce unnecessary utilization and costs for incidental pulmonary nodules,” wrote lead author Andrew B. Rosenkrantz, MD, MPA, of the department of radiology at NYU Langone Medical Center in New York City, and colleagues. “To achieve this aim, 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.”
Whether radiologists followed the Fleischner Society Guidelines or even recommended follow-up imaging was found to have less of an impact on downstream costs. “This likely relates to the ordering physician not following the radiologist recommendation in the majority of patients,” the authors wrote. “Indeed, it was the ordering physician that primarily impacted downstream costs.”
Michael has more than 18 years of experience as a professional writer and editor. He has written at length about cardiology, radiology, artificial intelligence and other key healthcare topics.