The "American Imaging Problem" that NIA is dedicated to addressing is not a matter of diplomacy or public relations. Rather, it relates to the increasing complexities and costs of advanced diagnostic imaging.
Here are the basics:
At a projected $100 billion annually, diagnostic imaging is one of the fastest growing cost areas in American health care. Outpatient imaging procedures increased 44% between 1999 and 2001. Driven by the advances in imaging technology, advertising directed at patients, a wide variation in appropriateness, and an aging population, radiology spending is expected to continue to grow at an annual rate of 20% or higher.
As shown in Figure 1, advanced radiology accounts for only 15% of the total volume of imaging encounters, but it represents half of a healthplan's overall radiology costs per patient per month and nearly three-quarters of its annual increase in total radiology costs.
Figure 1: The Cost of Advanced Diagnostic Imaging
Advances in technology will continue to inflate radiology costs for many years. According to The Wall Street Journal (5/20/02), GE Medical Systems predicts a 100% increase in the number of MRI scans done annually by 2005. The radiology equipment maker forecasts an even larger increase in PET technology. According to a recent study by IMV, the number of MRI procedures grew 22%, 2001 to 2002. PET procedures dramatically increased by 79% in the same time period.
The latest developments in imaging technology are also creating a "perfect storm" of complexity. These advanced procedures are by far the newest, most complex, and most difficult to administer in practice. They are also the hardest to match appropriately to each patient's diagnostic needs:
This growing complexity has led to wide variations in the appropriateness, pricing, and quality of imaging services.
In NIA's experience, about one third of advanced imaging tests are either inappropriate or do not contribute to the physician's diagnosis or ultimate health outcomes. They could possibly be performed more efficiently and economically with traditional technology. Applied to the nation as a whole, this data strongly suggests that efficient radiology benefit management could cut America's radiology expenditures by $20 billion to $30 billion annually.
As illustrated in Figure 2 below, a recent study by NIA shows that a very large portion of Chest CT tests are ordered inappropriately through abusive coding practices. In most cases, 10% to 100% of CTs are ordered with no claims evidence of a previous plain film of the chest. That pattern does not improve with increased use of Chest CTs (horizontal axis).
Figure 2: Potential For Abusive Coding Practices
Percent of 71250 Isolated Chest CTs without 30 Antecedent Chest Film
Total CT Studies
*Source: NIA claims database
Another recent NIA study shows that a large portion of MRIs are ordered to meet patient demand rather than a true diagnostic need. This is indicated by the fact that 10% to 100% of Brain MRIs are ordered without enhancement, a pattern that does not improve with increased utilization. See Figure 3.
Figure 3: MRI's Ordered to Meet Patient Demand
Percent of unenhanced brain MRIs vs total studies
Total MRI Studies
*Source: NIA claims database
To see why NIA is America's clear leader in helping the health care industry address the growing imaging problem, read about it from the viewpoint of patients, physicians, and plan partners.