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Imaging Overutilization

By Dr. Raag Airan

The road to overutilization is paved with good intentions. 

Taken from "Imaging Opportunities for Urology Physician Practices" 

A serious problem contributing to rising medical costs is imaging overutilization. Unfortunately, many of the recent proposals for addressing this problem are likely to be ineffective or even lead to more imaging use. 
Take the recent announcement by 
CareFirst that they will soon stop paying for second opinion reads of imaging studies. On its face, this is a clever way for CareFirst to limit its payout per patient. However, what this will likely do is instead lead to a) second opinion providers passing the cost directly to the patient, b) second opinion providers insisting on repeating imaging at their own facilities, and c) even higher barriers for patients to seek second opinions. The second opinion is a critical part of a consumer-based health 
care system, as it helps patients shop between doctors and choose the ones they feel are best for their care. All the CareFirst proposal will do is limit access to seconopinions and actually incentivize repeat imaging. 

Similarly, MedPAC has proposed to CMS a new imaging reimbursement formula that imposes at least 50% cuts for any imaging study reads for the same patient and physician on the same day. The essential idea is to address imaging overutilization through cutting radiologist professional reimbursement. Unfortunately, the radiologist has little control over whether a study is ordered, and the physicians who order repeat imaging are not at all affected by the radiologist reimbursement rate. Moreover, while larger group practices in urban centers can potentially maneuver around these rules, this will place a competitive disadvantage in rural areas, where largely solo practitioners practice, further limiting access to comprehensive care in those already underserved regions. While this may lead to small short-term savings in the form of some physician salaries, this cut won't affect the growth in imaging studies we perform – which has been increasing roughly ~29% annually for just radiation based imaging. 

Instead of these likely ineffective proposals, why don't we close the Stark Law loophole? Currently, because of this loophole, physicians are able to own their own CT or MRI and profit from its use. The data is clear that when a group purchases its own scanner, its rate of imaging usage rises dramatically. Vendors of these scanners have caught on and now target marketing materials to physicians to purchase a scanner, arguing they can improve their bottom line instantaneously - they just have to subject their patients to possibly needless studies and higher radiation doses. A relatively simple solution would be to close the loophole in the Stark Law that would otherwise prohibit clinicians from maintaining a financial interest in the studies they order. A similar law has already passed in Maryland. Why stop there?

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