Regional variation in imaging not best gauge for policy-making

2013 10 07 09 23 11 70 Rosenkrantz Andrew 200

Curbing geographic variation in imaging use and costs has been a major target of policy efforts in recent years. But it's unclear whether focusing on these factors is the best way to rein in Medicare spending, according to a new study published online in the Journal of the American College of Radiology.

"We need to better understand what the impact of regional variation in imaging use actually is," study author Dr. Andrew Rosenkrantz, from NYU Langone Medical Center, told "Current healthcare reform efforts view capping imaging costs as the end point, rather than evaluating the whole picture of how imaging is being used across the country."

The Patient Protection and Affordable Care Act (PPACA) of 2010 included reforms meant to improve the quality of healthcare while reducing costs -- and a key part of assessing quality and cost in healthcare is assessing geographic variation in the use of services across the U.S., according to Rosenkrantz (JACR, September 26, 2013).

Dr. Andrew Rosenkrantz from NYU Langone Medical Center.Dr. Andrew Rosenkrantz from NYU Langone Medical Center.
Dr. Andrew Rosenkrantz from NYU Langone Medical Center.

Before PPACA was passed, the U.S. Government Accountability Office (GAO) provided data to Congress that showed an unsettling rise in Medicare spending for imaging services, beyond spending for any other category of physician service. The GAO's report showed that considerable regional variation in imaging costs was part of this overall increase in spending, and that these regional variations could not be ascribed to differences in local health burden but rather to differences in physician practice patterns.

The GAO's report also noted that higher use rates of a particular health service didn't necessarily improve patient outcomes, according to previous research. The agency therefore recommended the use of "front-end" strategies such as prior authorization to contain imaging spending.

In the current study, using data from the U.S. Centers for Medicare and Medicaid Services (CMS), Rosenkrantz evaluated trends in regional variation in use and cost of imaging services in the Medicare population from 2007 to 2011 and compared them with regional variation in other health service categories.

He found that regional differences in imaging use were much lower than variations in imaging costs and variations in use of other major healthcare services, suggesting that using data on differences in imaging use may not be the best measure for making policy.

Variation in the mix of practice settings in different regions can result in disparities in the technical component of imaging fees, which can lead to cost differences out of proportion to those of use alone, according to Rosenkrantz. So perhaps the degree of variation in the use of Medicare imaging outlined in the GAO report -- which focused on costs rather than utilization -- may have been overstated, he wrote.

"The scope of the concern should be further evaluated in terms of utilization and within the context of the degrees of variation of other categories of healthcare services," he wrote.

Healthcare reform policies that focus on the front end of the cost issue may only end up limiting imaging access, Rosenkrantz said.

"Policymakers are focused on a particular angle of this problem: the costs of imaging and how to reduce them," he said. "Our study questions whether this is the best focus."

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