Imaging criteria credited in sharp Medicare spending decline

Washington Recent studies conclude that Medicare spending on imaging services has been declining, with physicians pointing to appropriate use criteria and other measures that control utilization of these services.

Imaging costs appear to have retreated somewhat after nearly a decade of significant growth rates. The Medicare program and its beneficiaries spent $10.9 billion for imaging services in 2010, according to a June 2012 Medicare Payment Advisory Commission report. That total represented a 5.4% drop in spending from the previous year. However, total spending on imaging services has risen 80% since 2000.

Another report from the Medical Imaging and Technology Alliance concluded that spending on the services declined 16.7% since 2006.

However, researchers still are taking a critical look at how much imaging services are utilized by physicians. A study in the December Archives of Internal Medicine study frequently found repeat echocardiography tests for Medicare beneficiaries, which suggested overutilization of the diagnostic service. Repetitive examinations of the heart provide insights on patient care and the ability to contain Medicare costs, the authors stated.

More than half of Medicare patients who had an echocardiography had a second test within three years. Imaging stress tests also were repeated within three years for 44% of patients. Nearly 50% of pulmonary function tests were repeated over the same period, too.

Lead author H. Gilbert Welch, MD, MPH, of Dartmouth College in New Hampshire, reviewed six diagnostic tests for which repeat testing is not routine. The study included a 5% sample of beneficiary services between 2004 and 2006.

“Although we expected a certain fraction of examinations to be repeated, we were struck by the magnitude of that fraction: One-third to one-half of these tests are repeated within a three-year period,” the authors wrote. “This finding raises the question whether some physicians are routinely repeating diagnostic tests.”

But the study shows trends during a specific period and not in a clinical context, said William A. Zoghbi, MD, president of the American College of Cardiology. The data do not provide underlying reasons for the repeated tests.

The time period used for the study also predates newer appropriate use criteria to prevent misuse of imaging services, although that does not mean there are no occurrences of overutilization, Dr. Zoghbi said. “I want to stress the fact that there are several situations that do not need frequent retesting.”

For instance, the American College of Cardiology is participating in the American Board of Internal Medicine Foundation’s Choosing Wisely initiative to provide physicians and patients with information to help them make health care decisions. The ACC asked its clinical councils to recommend procedures that should not be performed or should be provided only in specific circumstances.

One of five recommendations says that echocardiography as a routine follow-up for mild, asymptomatic native valve disease in adult patients with no change in signs or symptoms is not recommended on an annual basis unless there is a change in clinical status.