Here’s another reason health care聽inflation is down: The slowing growth in MRI scans, CT sessions and other diagnostic聽imaging聽that began聽in the mid-2000s聽has continued,聽paired with sharply lower聽Medicare reimbursements.
The end of the聽MRI boom聽may not rank with the poor聽economy, high-deductible health plans聽and expiring blockbuster drug patents as a factor in slowing聽cost trends — scans make up about 5 percent of total medical spending, according to the American College of Radiology — 聽but it should please insurers and government officials聽聽MRI scans聽can cost from $400 to more than $3,000 per pop.
“There has been聽a lot of attention focused on over-utilization of imaging,” said Dr.聽David C. Levin,聽chairman emeritus of the radiology department聽at Thomas Jefferson University Hospitals in Philadelphia.聽“Doctors all around the country are being聽bombarded with material and literature saying, ‘We’ve got to cut down on the use of imaging. We’ve got to try to reduce the cost of care.'”
Forthcoming papers by Levin and colleagues will show declines — not just slower growth — in聽outpatient MRI, CT and cardiac nuclear scans聽per Medicare beneficiary in 2010, “the first time” that has happened, he said. The group analyzed data from Medicare Part B. (A 2010 decline in imaging volume also shows up聽in the .)
It’s not just the rate at which doctors are聽ordering and performing diagnostic radiology that has changed.聽They’re getting paid less for it,聽too,聽at least by Medicare. published by Levin’s team in the Journal of the American College of Radiology shows a 21 percent plunge聽in spending on diagnostic imaging by Medicare Part B from 2006 to 2010 — from $11.91 billion to $9.46 billion.
Several years ago聽the government聽began cutting what it聽paid for MRI scans, demanding discounts for multiple examinations聽in the same session, changing the formula for calculating physician聽expenses and making other payment adjustments. Everybody knew reimbursements were down, Levin said, “but I don’t think people were aware of the aggregate effect.”
What’s going on in Medicare is probably happening with private聽health insurers, too, he said. Most聽have hired “radiology benefit management” companies聽to second-guess doctors who聽order expensive scans.聽Levin believes RBM firms聽may be the most important factor in reducing the growth in聽radiology procedures.聽While Medicare isn’t using them聽yet, knowledge that somebody is looking over their shoulder has probably prompted physicians to order fewer scans for all their patients, he said.
With the expansion of coverage promised by聽the Affordable Care Act, “it’s possible that the use of imaging might go back up in the general population, but nobody really knows” he added. “In the Medicare population you’re going to continue to see a drop-off.”
