Overuse of medical imaging services are driving up U.S. health care costs
10 11 08 - 13:15
Rising use of medical imaging raises costs and health concerns
By Lisa M. Krieger
Mercury News
Medical advances such as CT scans that offer doctors highly detailed images of the body's inner workings are overused, increasing costs and patients' exposure to radiation, according to a new study.
The provocative conclusion by a UC San Francisco research team challenges the more-is-better conventional wisdom of many consumers and their doctors.
The use of innovative imaging tests like computed tomography (CT) and magnetic resonance imaging (MRI) nearly doubled over the past decade, rising from 260 to 478 tests per thousand patients, according to research led by Rebecca Smith-Bindman, an associate professor of radiology at UCSF.
The average annual imaging cost per patient also doubled, from $229 to $443, the team found.
Tests like CT and MRI, which offer stunning three-dimensional images of tissue and bone, were intended to replace older and less accurate tests, such as standard X-rays. Instead, the once-exotic tests designed for detecting grave illnesses like cancer are often used for such routine problems as headaches and respiratory infections, she said.
"The new technologies are fantastic," she said. "But they should be used judiciously.''
CT and MRI have joined the long list of tests given during diagnostic workups, according to her team's study of a decade-long record of almost 400,000 patients in a large Washington state health plan, published in Monday's issue of the journal Health Affairs. The results can be extrapolated to the rest of the nation, according to the team.
Medical imaging such as MRI and CT scans is the most costly type of health care technology and is one of health care's fastest growing sectors, rising at three times the rate of other medical services, according to the consulting firm Booz Allen Hamilton. Imaging is a powerful driving force behind the nation's soaring health care costs, second only to prescription drugs.
But what seems expensive and excessive may actually offer huge benefits, said Geoffrey Rubin, Stanford School of Medicine radiology professor.
"If imaging resulted in a more expedient or accurate diagnosis leading to earlier or more appropriate treatment — then overall health care costs, time away from productive lives and jobs, and general quality of life could have substantially improved," Rubin said.
Using the study's logic, he said, the added cost of routinely installing car airbags would seem excessive "if we did not also know that air bags actually save lives.''
Imaging supporters say the radiation risk is small compared with a snapshot of a life-threatening infection, troubling plaque on a heart vessel or blood clot in the lungs.
Imaging can actually cut costs and reduce sickness, said Arl Van Moore of Charlotte, NC., president of the American College of Radiology. Thirty years ago, a diagnosis of pancreatic cancer used to require open surgery — now a CT scan can find a mass. Mammograms have helped reduce deaths resulting from breast cancer, he said.
To reduce overuse, the American College of Radiology has created criteria to guide doctors so that "the right exam is done for the right reason,'' Van Moore said.
Smith-Bindman's study, which studied data from patients enrolled in the health maintenance plan called Group Health Cooperative, found that 13.5 percent of the study group had undergone CTs, MRIs, or both, in 1997; by 2006 it was 21 percent. Study results showed the per-patient number of CT scans doubled throughout the 10 years, and the number of MRI scans tripled.
Imaging with conventional X-rays remained relatively stable — rather than declining, as expected.
The study confirms previous reports of a trend toward over-imaging. Because the Group Health-managed care system has no financial incentive to do extra tests, the trend may be even more pronounced in traditional fee-for-service practice health plans, she said.
The research did not study whether the increases in advanced imaging was associated with improvements in patient care.
Generating tens of billions of dollars each year, diagnostic imaging has become a lucrative part of modern hospital practice. The tests also reassure doctors that they haven't overlooked anything. A survey of doctors in the Journal of the American Medical Association found that more than half ordered imaging tests just to shield themselves from lawsuits.
Consumers are also driving the trend, Smith-Bindman said.
"Patients believe that getting a CT scan, for instance, is a measure of high-quality care. It feels like you're doing something,'' she said.
Before undergoing the tests, Smith-Bindman encourages patients to ask their doctors: "'What will we learn from this test? And how will it improve my care?' We need to sit back and ask: 'When is this really helpful?:'"
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