Appropriate Guidelines Necessary to Reduce Imaging Excess

A recent study demonstrates that appropriateness practice guidelines and tools reduce imaging use and cost while preserving access.

The Medical Imaging Technology Alliance (MITA; Rosslyn, VA, USA) reported on March 6, 2009 that a recent study conducted by researchers at the University of Florida Health Center (Gainesville, USA) and Massachusetts General Hospital (Boston, MA, USA) demonstrates the clear benefit of using appropriateness criteria to help curb growth rates in advanced imaging utilization.

"This study provides groundbreaking evidence affirming that appropriateness criteria is the key to ensuring patients get the right scan at the right time," said Dr. Ilyse Schuman, managing director, MITA. "MITA applauds the work of Dr. Sistrom [from the University of Florida] and his team, whose research demonstrates that when appropriateness criteria is integrated into physicians' practices, imaging utilization and its associated cost are significantly reduced, while still ensuring patients have access to the services they need. This study confirms that the appropriateness criteria provisions in last year's [U.S.] Medicare bill, and not preauthorization requirements delivered by radiology benefit managers, are the right way for policymakers to ensure the proper use of advanced imaging equipment and generate savings without compromising access to life-saving diagnostic services."

The study, led by Dr. Christopher L. Sistrom, evaluated the effect that certain appropriateness criteria measures--specifically a computerized radiology entry (ROE) and decision support (DS) system--have on the growth rates of outpatient computed tomography (CT), magnetic resonance imaging (MRI), and ultrasonography (US) procedures over time. The ROE system was introduced in 2001 to assist physicians in making their decisions ordering high-cost imaging tests. DS was implemented three years later, providing physicians with a 1-9 appropriateness score for their diagnostic recommendation after clinical indications for the patient had been provided.

Based on a statistical analysis of data accumulated between October 2000 and December 2007, Dr. Sistrom and colleagues found that the implementation of the ROE and DS system led to a drastic decrease in high-cost imaging growth. Even as outpatient visits increased at a compound annual rate of close to 5%, the annual outpatient CT growth rate decreased from 12% to 1%, while MR imaging and US annual growth rates each decreased by 5%, from 12% to 7%, and 9% to 4%, respectively. The researchers concluded that, "introducing computerized ROE with DS...may substantially reduce the growth rate of high-cost outpatient imaging volumes."

The Medical Imaging & Technology Alliance (MITA), a division of the U.S. National Electrical Manufacturers Association (NEMA), is the collective voice of medical imaging equipment manufacturers, innovators, and product developers. It represents companies whose sales comprise more than 90% of the global market for medical imaging technology. These technologies include: medical X-ray equipment; CT scanners; ultrasound; nuclear imaging; radiation therapy equipment; MRI; and imaging information systems.

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