Problem:
Growth in High-End Imaging
Advanced Medical Imaging Today
Rapid growth in advanced medical imaging is driving up Medicare costs and contributing to double-digit increases in Medicare premiums paid by older Americans. According to the Medicare Payment Advisory Commission (MedPAC), high-end medical imaging (CT, PET, and MRI) is the fastest growing type of physician services expenditure in the United States, with an annual growth rate that is more than twice that of other physician services. A significant portion of this imaging is justified. But a large and growing share of high-end testing may be unnecessary - increasing costs and putting patients safety at risk. Increasingly, physicians who are not trained in medical imaging are investing in CT, PET, and MRI equipment and profiting by ordering and performing these procedures in their own offices.
Authoritative studies demonstrate that this spike in advanced medical imaging poses serious quality and safety problems. A Government Accountability Office (GAO) study found that physicians with access to imaging services within their practices ordered twice as many CT scans and three times as many MRI scans for their patients as other physicians. Blue Cross Blue Shield of Missouri concluded that nearly one third of advanced imaging procedures ordered by untrained medical imagers may be unnecessary. So why is advanced medical imaging experiencing such tremendous growth?
The Problem: Financially Driven Self-Referral and Lack of Quality Standards
A number of factors contribute to the growth in advanced medical imaging and the rise in Medicare costs, including:
- A growing number of physicians are profiting financially by investing in their own equipment and then ordering their patients to undergo a disproportionate number of tests.
- Fueled by recent cuts in Medicare physician reimbursement rates, many physicians who lack training and expertise in radiology are installing MRI, CT, and PET scan machines in their own offices nominally to help their patients, but also to supplement their incomes. This surge of nonradiologist medical imagers performing diagnostic imaging is helping to drive up premium costs and may threaten the safety of patients.
- Medicare data show growth in utilization of imaging among physicians who are not trained in radiology is more than twice that of highly trained imaging professionals.
- A study published in the Journal of the American Medical Association shows that nonradiologists who perform their own imaging procedures are up to 7 times more likely to order tests than physicians who refer their patients to independent medical imagers.
Lack of standards for medical imagers and equipment is threatening patient safety and quality of care.
Rapid advances in CT, MRI, and PET technology are producing more compact and cost-effective medical imaging equipment. While these advances are permitting faster, more complete and accurate diagnoses by medical specialists, they are also fueling a system wherein some physicians with little or no training in radiation safety and other essential disciplines are conducting in-office, high-end imaging testing. These tests are often not conducted with the safe regard for quality and safety as those conducted by those specifically trained to conduct medical imaging tests.
Certain states and localities and many private sector health plans have begun to establish their own quality requirements, but there are no minimum federal quality standards to ensure that imaging machines work properly and that technicians and physicians are appropriately trained.
Private sector experience with quality standards shows that:
- Except for radiologists and cardiologists, a high percentage of imaging facilities were not able to pass a quality inspection. (Verilli et al. 1998)
- Serious quality deficiencies were found in a high percentage of nonradiologists' offices. (Moskovitz et al. 2000)
Deficiencies, such as image quality or patient safety, are up to 10 times as common among nonradiologists as among radiologists. (Kouri et al. 2002.