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Measuring the Effectiveness of Imaging Tests Not Clear Cut

Carrie Vaughan, for HealthLeaders Media, September 15, 2009

Even though one-third of healthcare providers are continuing a freeze on purchasing imaging equipment, many are in the market to buy again with MRI equipment topping the list for planned imaging equipment purchases in the next two years, according to a new report from KLAS, an independent research organization that monitors the performance of HIT software and medical equipment vendors in Orem, UT.

At the same time, the federal government is looking for ways to reduce its imaging costs, which more than doubled to $14 billion between 2000 and 2006 for Medicare beneficiaries. One strategy is to reduce reimbursement for providers by lowering the value of equipment factored into the payment equation.

Another strategy is to require preauthorization for imaging tests like CT, MRI, and PET scans much like the radiology benefits managers used by some private insurers. A U.S. Office of Inspector General report, which found evidence that doctors in certain geographic areas may order significantly more unnecessary ultrasounds than physicians in other regions, added more ammunition to the debate that Medicare should adopt an RBM model.

However, measuring the effectiveness of imaging tests and determining when tests are appropriate is not as clear cut as one may think. I spoke to Jeffrey Barth Weilburg, MD, associate medical director of the Massachusetts General Physician Organization, which represents approximately 1,600 employed physicians at MGH, for the HealthLeaders magazine story, "How Many Slices Do You Really Need?" (September 2009).

The article offered strategies organizations can use to determine when they need to purchase imaging equipment and how they can ensure the equipment is being used appropriately. His organization, which launched a radiology order entry system in 2001, is just now starting to evaluate whether they can determine if tests are effective.

For instance, if a primary care physician orders a CT scan for a patient suffering from a bad headache and the exam shows that nothing is wrong with the patient, was that test effective or unnecessary? It may depend on who you ask, says Weilburg. The patient who is no longer worried about a brain tumor may say the exam was very effective, but an RBM may say it was unwarranted based on the patient's case.

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