Whitney Palmer

Healthcare. Politics. Family.

Report Offers System to Separate Useful and Wasteful Imaging

Published on the Feb. 20, 2013, Diagnostic Imaging website

By Whitney L.J. Howell

All repeat images are not created equal. Some are good; some are wasteful. So one radiology policy think-tank introduced a classification system Wednesday that could help determine whether a repeat image is necessary.

According to Richard Duszak Jr., MD, CEO of the American College of Radiology’s Harvey L. Neiman Health Policy Institute, “repeat image” is an overused and undefined term that offers no clarity about a scan’s medical necessity. The institute, , which researches medical imaging use, quality, and safety metrics, published guidance about how to categorize the various types of repeat images.

This paper, entitled “Repeat Medical Imaging: A Classification System for Meaningful Policy Analysis and Research,” aims to help quantify how many imaging studies have beneficial diagnostic value and how many can be avoided as wasteful spending.

“This classification system is in response to what we perceive as a global lack of clarity as to what repeat imaging means in medicine and when it applies to imagining,” said Duszak, who is also a practicing radiologist. “We’ve tried to be as thoughtful as we could be in creating something that would work both now and with future research as people have more and more robust data.”

The system divides medical images into four categories: supplementary, duplicative, follow-up, and unrelated imaging:

• A supplemental image — many of which are medically necessary — would occur during the same clinical encounter but utilize a different modality, such as a non-contrast CT scan and a renal ultrasound to identify kidney stones.

• Duplicative images involve the same modality during the same or subsequent clinical session. These images are taken for a variety of reasons, including the unavailability of previous scans or a change in the patient’s condition.

• Follow-up imaging can involve the same or different modalities during later clinical meetings, such as repeated imaging in cancer patients to verify there’s been no relapse of disease.

• Unrelated imaging — scanning of the same body area with any modality — is often an unforeseen event. For example, in its paper, HPI discussed unrelated imaging in a woman who had CT screenings for breast cancer staging two weeks prior to a car accident that prompted identical scans.

In many instances, how well researchers will be able to use this classification system will depend on how integrated and mineable the electronic health records they use are, Duszak said, as well as how standardized radiology reports are.

To read the remainder of the article at its original location: http://www.diagnosticimaging.com/practice-management/content/article/113619/2129299


February 26, 2013 Posted by | Healthcare | , , , , , , , , , , | Leave a comment

Radiologists Should Worry About Medical Device Tax, Too

Published on the Jan. 10, 2013, DiagnosticImaging.com website

By Whitney L.J. Howell

On January 1, the long-debated and much-opposed medical device tax went into effect. To date, medical device manufacturers have clearly stated their opposition, but industry leaders portend practicing radiologists also have reason to be concerned.

Barely a week old, this measure levies a 2.3 percent tax on all medical devices. The law calls for manufacturers to pay for the tax added to the sale price of the device, but many worry the cost will not only trickle down to providers, but will also, ultimately, stymy the progression of patient care by hindering research and development efforts.

“As radiologists, most of us chose the specialty because it’s a field that incentivizes technological innovation that can make enormous differences in patient care,” said Geraldine McGinty, MD, chair of the American College of Radiology (ACR) Economics Commission. “Payment or health care policies that would, in any way, negatively impact innovation are things that make us feel uncomfortable.”

The device tax will inevitably impact practitioners’ bottom lines, she said. The actual dollar amount is yet unknown, but manufacturers will be forced to pass some of the tax increase on to their customers. The price hike will likely be an unwelcome addition to existing imaging reimbursement cuts and the difficulties radiologists already face with collecting payments from patients. Equipment purchasing decisions could become more complicated or could be postponed, she said.

In addition to individual monetary concerns, radiologists should also worry about what the medical device tax could mean for their ability to provide the most up-to-date patient care. According to the Medical Imaging and Technological Alliance (MITA), this initiative is a job-killer because it makes outsourcing jobs overseas more attractive. But research and development efforts will also be a casualty, said MITA Executive Director Gail Rodriguez.

According to a recent MITA survey, 29 percent of manufacturers anticipate slicing into their research and development budgets as a way to cover the anticipated $287 million associated with the device tax. This change could leave providers without new technological innovations for treating patients, MITA said.

To read the remainder of the story at its original location: http://www.diagnosticimaging.com/practice-management/content/article/113619/2122393

January 14, 2013 Posted by | Healthcare, Politics | , , , , , , , , , | Leave a comment

JAMA: Imaging Use Up in HMOs; Industry Leaders Disagree

Published on the June 14, 2012, DiagnosticImaging.com website

By Whitney L.J. Howell

Changes to Medicare reimbursement and other financial incentives designed to control the use of diagnostic imaging services aren’t working as expected, even in clinical settings without a fee-for-service payment model, according to a study published earlier this week in the Journal of the American Medical Association. However, not all industry leaders agree that imaging utilization is on the rise.

A retrospective study of up to 2 million electronic health records from 1996 to 2010 from six health systems with health maintenance organizations (HMOs) revealed the number of diagnostic imaging studies performed increased between nearly 8 percent to 57 percent during that time period.

The findings, compiled by researchers at the University of California-San Francisco (UCSF), showed the number of ultrasounds doubled, CTs tripled, and MRIs quadrupled during those 15 years. These results indicate that financial disincentives, such as lowered reimbursement or added cost to the patient, aren’t enough to eliminate unnecessary testing, as once was the hope, researchers said.

“Some people are just unrealistically enamored with diagnostic tests. There’s a perception that there’s no harm to these tests, so we can do them and think about the results later,” Rebecca Smith-Bindman, MD, UCSF radiology and biomedical imaging professor and lead study author, said in an interview. “The pictures are extraordinary, and some patients receive enormous benefits from having these tests. But others receive no help at all — they face high radiation doses, false positives, and more unnecessary downstream testing.”

Fear of facing malpractice suits and of missing a malignancy also pushes providers to order diagnostic studies for which there is no true medical indication, she said. If these problems were resolved, she said, radiologists and referring physicians could likely avoid 30 percent to 50 percent of diagnostic studies.

Even an industry-wide shift to an accountable care organization (ACO) or bundled payment model is unlikely to be enough to drive down imaging utilization, she said. Instead, medical imaging should invest in comparative effectiveness studies to better understand when imaging is appropriate. Industry leaders can, then, use that information to create clinical guidelines.

However, several groups, including the American College of Radiology (ACR), the Medical Imaging and Technology Alliance (MITA), and the Access to Medical Imaging Coalition (AMIC) said the study’s findings actually supported existing evidence that imaging use is decreasing.

To read the remainder of the article at its original location: http://www.diagnosticimaging.com/low-dose/content/article/113619/2083399

June 18, 2012 Posted by | Healthcare | , , , , , , , , , , , , , , , , , , , , , , , , | Leave a comment


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