Many US Hospitals Losing Imaging Volume to Private Practices

At a time when imaging volume is being targeted as a factor in the overall rise in healthcare costs in the United States, a look at national insurance data from a 10-year period has revealed that although there has been steady growth in imaging, a large part of that growth can be attributed to studies performed by nonradiologist physicians in the private office setting.

The study, performed by radiologists David C. Levin, M.D., Vijay M. Rao, M.D., and colleagues from Thomas Jefferson University Hospital (Philadelphia, PA, USA), was published in the February 2009 issue of the Journal of the American College of Radiology (JACR). The study examines the changes in imaging volume in four groups where imaging most often takes place: in the hospital inpatient setting, hospital outpatient facilities, private offices or imaging centers, and emergency departments (EDs).

The study results indicate that the utilization of imaging in the private office setting increased by 63%. Overall hospital market share decreased from 47% in 1996 to 41% in 2006. ED imaging saw the fastest growth at 77%, however, the utilization of imaging in the ED were considerably lower overall than the other three groups being studied.

In order to contain imaging growth, fight misuse of the technology, and educate referring physicians about appropriate ordering of exams, authors David P. Friedman, M.D., and colleagues enlisted their department in a utilization management (UM) program directed by a radiology benefit management program. Their study details the process by which imaging studies are approved using evidence-based guidelines from a variety of sources. The department noted a reduction in unnecessary studies: 14% of all studies reviewed were not performed, and about 6% of those ordered were reordered with a more appropriate exam.

In the article, Gregory J. Butler, M.D., reported professionalism as forthcoming topic of importance in radiology that is to be looked at as an opportunity for development. Professionalism may be the only behavior that is likely to save radiologists from extinction, according to the investigator, as the radiology profession is quickly changing. As teleradiology gains footing, and face time with referring physicians continually decreases, radiologists' apathy is becoming an increasing threat to the profession.

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