Blog | Monday, August 6, 2012

QD: News Every Day--Policies slowed demand for radiology, radiologists

Prior authorization, increased cost sharing, and other policies appear to have contributed to the slowdown in radiology services, particularly in imaging studies previously identified as having unproven medical value, researchers concluded.

What had been a decade of 6% growth in the use of radiology services for Medicare beneficiaries decelerated in 2006 and 2007.

Researchers first applied data from a 5% sample of Medicare beneficiaries from 2000 to 2009. To determine whether slowing utilization extended to the insured population outside of Medicare, researchers reviewed imaging study claims from three commercial insurers: a multistate insurer covering 47 employer-sponsored plans with enrollment of approximately 1.1 million people; a second multistate insurer covering the more than 5 million nonelderly people in preferred provider organizations; and claims from 250,000 people enrolled in health maintenance organizations or point-of-service plans operated by a third commercial insurer in a single northeastern state.

Results appeared in the August issue of Health Affairs.

Growth of imaging use among both Medicare beneficiaries and the non-Medicare insured slowed to 1% to 3% percent per year through 2009.

For example, use of CT in the sample of 47 employer-sponsored plans grew at an annual rate of 20.4% from 2002 to 2006, but annual growth slowed to 3.1% from 2006 to 2009. In the same sample, MRI use grew 16.6% annually from 2002 to 2006 but grew only 1.1% per year from 2006 to 2009.

As another example, in the large-insurer preferred provider organization sample, use of CT increased by an average of 0.5 percent per year from 2007 to 2010, while use of MRI was flat. Data from the single northeastern state sample show that use of MRI increased at an annual rate of 5.6% from 2005 to 2009--an outlier--while CT use increased at an annual rate of 2.1%.

At the root of the reduced demand for imaging was limits placed on procedures of limited value, for example, MRI of the lumbar spine used to diagnose lower back pain, MRIs of joints used to diagnose elbow and knee pain that responds to conservative treatment such as exercise, and pelvis CT as an add-on to an abdominal CT.

The authors wrote, "What has occurred in the imaging field suggests incentive-based cost control measures can be a useful complement to comparative effectiveness research when a procedure's ultimate clinical benefit is uncertain."

Radiologists, who until recently could demand top salaries and preferred job locations, now face a softening job market.

At the same time as cost control measures reduced the demand for images, digital workstations and teleradiology increased radiologists' capacity to read more images, by as much as 18% by one estimate. The study authors reported that several hospitals fired their in-house radiology groups after contentious negotiations, and other hospitals demanded concessions that led to cardiologists and urologists to read their own imaging studies.

The resulting excess capacity weakened radiologists' bargaining power.