Research reveals 2 key clinician-level predictors of low-value imaging

Targeting and eliminating unnecessary care has become increasingly important in radiology as the industry has dedicated more and more resources to cutting costs and improving quality. According to a new study in JAMA Internal Medicine, determining clinician characteristics associated with low-value imaging is a step toward reducing such imaging, which saves patients from receiving services they don’t need and helps keep costs down.

“Previous research has found that patients gain little reassurance from a negative low-value study, and because of increasing patient cost sharing, low-value imaging will increasingly cause ‘financial toxicity’ to patients.” wrote Arthur S. Hong, MD, MPH, University of Texas Southwestern Medical Center in Dallas, and colleagues.

To identify clinician predictors of low-value imaging, Hong and colleagues studied medical claims data from January 2010 to December 2014, focusing on inappropriate back pain and headache imaging. “In the absence of certain signs or symptoms indicating a serious underlying cause—such as neurologic problems, history of cancer, or unexplained fever—radiograph, computed tomography (CT), or magnetic resonance imaging (MRI) imaging within the first six weeks of acute uncomplicated back pain adds little to no clinical value,” the authors wrote. “Similarly, for headache without neurologic symptoms or signs of a serious underlying cause—such as trauma or history of cancer—CT or MRI imaging are not recommended.”

These are two clinician predictors revealed by the team’s study:

1. Imaging for the Prior Patient: One of the biggest takeaways from the team’s findings was that clinicians are much more likely to order low-value imaging if they had ordered such imaging for their prior patient.

According to the data associated with low-back pain, if a primary care physician had ordered imaging for his or her prior patient, their odds of ordering imaging were 2.08 times higher. The numbers were even higher for chiropractors (2.80 times higher) and specialists (2.98 times higher) who had ordered imaging for their prior patient.

According to the data associated with uncomplicated headaches, if a clinician had ordered imaging for his or her prior patient, their odds of ordering imaging were 2.20 times higher.

2. Ownership of Imaging Equipment: The authors also found that clinician ownership of imaging equipment was a “consistent independent predictor of low-value imaging.”

Ownership of imaging equipment made chiropractors a whopping 7.76 times more likely to order low-value imaging for low-back pain. In addition, ownership of imaging equipment made clinicians 1.88 times more likely of ordering low-value imaging for an uncomplicated headache.

“Addressing ownership, previous legislation has limited imaging equipment ownership and clinician self-referral; however, exceptions have been made for patient convenience and evolving practice models,” the authors wrote. “As a result, these laws may be less effective than intended.”