ACR: Health Affairs Study on Imaging Doesn’t Tell Full Story

The ACR has gone on the offensive to counter possible misunderstandings about imaging that may result from a new study in the the August issue of Health Affairs. The study found that the use of advanced imaging for Medicare patients decreased in 2006 and 2007, after 10 years of rapid increase (more than 6% growth annually) in imaging utilization. After 2007, growth returned but only at 1% to 3% per year. Calling the study "incomplete and possibly misleading" in a press statement, the ACR pointed out that some factors that may have contributed to the decline of advanced imaging use for Medicare patients are left out of the study. The study credits the expansion of prior authorization, increased cost sharing, and other policies as factors in the slowdown of imaging use. However, the authors did not discuss the field’s own efforts to curb overutilization, such as the ACR’s appropriate imaging initiatives -- Image Gently and Image Wisely -- which educate referring physicians and help them follow ACR evidence-based appropriateness criteria and best practices when ordering studies. Another important factor not covered by the study, the ACR stated in the press release, is the development and spread of electronic physician order entry systems that can provide decision support at the time an imaging procedure is being considered. A tool with this type of real-time actionable information has been shown by researchers to to improve quality, reduce unnecessary scans and lower imaging costs. In addition, the ACR asserted that the rise in ACR accreditation among imaging facilities could also be a factor in reducing duplicative studies because improved standards lessens the need for redoing studies due to poor quality images. Finally, the ACR faulted the study authors for not discussing the potential downsides of a reduction in use of imaging in Medicare patients. This could leave some with the impression that all the studies that were not done were wasteful, and that may not be true. The ACR pointed out that a study Health Affairs itself published just eight months ahead of this one found that as many as 12,000 American seniors may have suffered broken bones due to Medicare cuts in reimbursement for dual energy X-ray absorptiometry (DEXA). Researchers could likely find more examples of negative consequences of imaging reimbursement cuts if the findings of studies into the benefits of imaging hold true, the ACR hints. Studies have found that:

• Imaging exams are linked to greater life expectancy.
• For many indications, imaging is liked to declines in mortality rates.
• Imaging reduces use of surgeries and unnecessary hospital admissions.
• Imaging reduces the length of hospital stays.

“This Health Affairs study further supports the fact that medical imaging scans are being more efficiently used and are not a primary driver of rising healthcare costs," said Paul Ellenbogen, MD, FACR, chair of the American College of Radiology Board of Chancellors in the press release. "Medicare spends the same amount on imaging services now as in 2003 — virtually unheard of in the health care arena. This is likely the case among the privately insured as well. Those who contend that imaging is primarily responsible for rising costs are either misinformed or purposefully misinforming others. RBMs deny needed care and intrude on the doctor-patient relationship at critical times. Arbitrary, backward looking limits on care may slow or even reverse gains against cancers and other serious illnesses and deny patients access to potentially lifesaving services. This can’t be allowed to happen,”

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Read the Health Affairs study: "The Sharp Slowdown In Growth Of Medical Imaging: An Early Analysis Suggests Combination Of Policies Was The Cause." Read the ACR press release response.