PHOENIX - There's an elephant in the radiology department and no one wants to acknowledge its presence. The radiologists know about it, as do the residents and the technologists, mostly because they run into this elephant at least once a day. The elephant in the room is the inappropriate ordering of imaging services.
The unprecedented growth of diagnostic imaging in the past few years has placed it in the center of the reimbursement reduction bull's-eye, according to Dr. Thomas Dehn, president and CEO of the radiology benefits management firm National Imaging Associates in Hackensack, NJ. Dehn is also a fellow with the American College of Radiology (ACR).
"The cost of diagnostic imaging has skyrocketed beyond any intuitive reason," said Dehn in a presentation this week at the Radiology Business Management Association (RBMA) conference.
"If you increased diagnostic imaging costs by 50% over the past three years -- which is, in fact, what's happened -- then you sort of have to say that either people are 50% better, because the money's been spent that way, or you have to say that they suddenly got 50% sicker and that's why there's been all this diagnostic imaging," he said.
Dehn cited statistics derived from National Imaging Associates estimates that placed the cost of U.S. diagnostic imaging in 2005 at approximately $100 billion. This represents a 19% inflation rate from the prior year with MR, CT, PET, and nuclear cardiology imaging shooting up between 20% to 30%, and all other imaging modalities growing approximately 10% to 15% from the previous year.
On a per-member, per-month basis, health plans have seen the cost of diagnostic imaging rise from a little over $16 in 2005 to nearly $19 in 2005, Dehn said. This cost increase was primarily due to utilization, not unit cost per procedure, he asserted. From 2000 to 2003 diagnostic imaging costs nearly doubled on a per-member, per-month basis; however, the price of imaging procedures on a per unit basis actually declined over the same period.
Although there has been a rapid climb in the utilization of in-office imaging by other clinical specialties -- most egregiously by nuclear cardiology, according to Dehn -- this does not cover an overall 50% increase in diagnostic imaging procedures.
Dehn attributes a majority of the increase to inappropriate ordering of diagnostic imaging by clinicians. This has led to proposed severe cutbacks to reimbursement of radiology's unit costs, such as those in the Deficit Reduction Act (DRA) of 2005, he said.
A former private-practice radiologist, Dehn said he knew all too well the dilemma that radiologists face when presented with an inappropriate imaging order from a referring clinician.
If a radiologist turns down an order as inappropriate, the group runs the risk of losing all referrals from that physician. In a hospital setting, radiologists who reject orders as inappropriate risk alienating hospital administration, as well as losing orders to other specialties as part of the ongoing interdepartmental turf battles within institutions.
A result of these circumstances has been the growth of radiology benefits management firms. Although these firms are viewed by most referring clinicians as yet another hurdle placed in the way of healthcare delivery, they may help throttle back the projected volume of diagnostic imaging, which threatens to overwhelm existing resources in the U.S.
For radiology groups that are leery of radiology benefits management firms moving into the market and trimming practice margins, Dehn counseled that demographic trends play in their favor.
"If a good, efficient (radiology benefits management firm) comes into town, your volume may go down, but your year-over-year increase probably will still be positive," he said. "The fact is that the aging of the population and the introduction of new technology offsets a fair amount in the diminution of the volume."
By Jonathan S. Batchelor
AuntMinnie.com staff writer
October 25, 2006
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