Use of imaging services–x-rays, CT, MRI, PET and various other scans–has grown incredibly rapidly in the United States. CT scans for example went from 3 million in 1980 to over 70 million last year. Hard to imagine all those scans are really needed or useful. The explanations vary from legitimate improvement in diagnostic information and avoidance of invasive procedures to defensive medicine to physician ownership of facilities. In the current health reform debate, imaging became a prime example of overuse that was causing the continued rapid increase in spending and Medicare use of management techniques now popular in the private sector became a heated point in the construction of the current legislation. All the fuss may have been after the fact, because the private sector at least has been able to put the brakes on utilization and cost and even Medicare appears to be reducing the rate of growth in its imaging spend, both by payment changes and probably spillover from the private efforts.
The most recent focus is on the dangers of all the radiation involved in scanning. The Wall Street Journal ran a recent story on attempts to reduce CT radiation exposure. (WSJ Story) The New England Journal of Medicine reports on a study indicating that only a minority of coronary angiograms provided useful information. The study and accompanying editorial suggest that a very large percent of cardiac scans are not ordered in conformance with guidelines. This not only drives up costs but creates risks for patients. (NEJM Article) (NEJM Editorial)
But cost continues to be an issue as well. The Boston Globe reported on imaging’s contribution to the rapid rise of spending in Massachusetts. (Globe Story) Outside researchers hired by the state government attributed half of the spending increases to price increases and the rest to volume growth. A shift in imaging site from free-standing facilities to hospitals also contributed to the price increases, as did use of fancier procedures, such as digital mammography, which don’t necessarily produce better information, but which cost more. The end result of all this attention to imaging has probably been very positive; there appear to be fewer unnecessary scans, patients are avoiding potentially dangerous radiation levels, and costs have leveled off.