Regents Health Resources

On June 12, the Los Angeles Times reported that the U.S. spends $100 billion a year on advanced imaging like CTs, MRIs and PETs that provide no value. The solution favored by the federal government and insurance companies has been to cut reimbursement for these diagnostic tools.

It is true that advanced imaging is often misused. In the United States, imaging can be extremely lucrative for the physician or institution that owns the imaging device. By comparison, on average, MRIs are paid three times more in the U.S. than in Canada and five times more than in the United Kingdom. In the U.S., incentives exist to order imaging inappropriately.

But advanced imaging is also clinically productive and is one of our most capable and promising diagnostic tools. Imaging allows doctors to visualize and understand internal body structures and processes with startling speed and clarity without the trauma associated with surgeries. As the technologies continue to become more intelligent and powerful — and they will — we should want to make advanced imaging more … not less … available.

Inappropriate and excessive delivery of care is not unique to advanced imaging. It is rampant throughout American healthcare. Cardiac stents in stable heart patients provide no advantage over drug therapy, but because they are profitable, cardiologists continue to install them in these patients. The U.S. Preventive Services Task Force has concluded that routine screening colonoscopies for patients over 75 provide little benefit, yet Medicare continues to pay for them.

In imaging and all of healthcare, we should want to encourage the delivery of appropriate services. That will require payment that rewards clinicians for efficiently managing the care process rather than for providing another product or service. Simply paying less to discourage use of advanced imaging is a blunt instrument. Looking to the future … using outcome data to guide use decisions and paying differently to encourage appropriateness is the smarter approach.

Based in Franklin, Tenn., Regents Health Resources is a national consulting firm focused on the complexities of medical imaging.  Regents also owns National Imaging Network, an imaging provider collaborative using data to optimize operations. www.regentshealth.com

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