After years of increased usage, the volume of advanced imaging tests like CT and PET scans and MRIs has started to drop, although only slightly, according to an independent analysis of Medicare claims data between 1999 and 2009. The amount of overall imaging has dropped by 7.1%.
The report, released by the Access to Medical Imaging Coalition (AMIC), was prepared by The Moran Company, a Washington-D.C.-based research and consulting firm for healthcare providers.
"What's happened is essentially two things," says Don Moran, president. "Reimbursement for the technical component of imaging, which has an impact on the people who own the equipment, the radiology groups, has gone down," from its peak in 2005 and 2006.
Second, he says the recession has had a huge impact on imaging use because so many people who lost jobs also lost their health coverage and can no longer afford elective medical care. "Those two factors are large enough to see these effects," he says.
He adds that "anecdotally, what's being reported in areas like cardiology is that (doctors) who previously were doing imaging tests in the community are selling those practices out to hospitals or merging...because the economics are going in the other direction."
An executive summary of the report shows that spending for advanced diagnostic imaging services reached a 10-year high in 2006, but began to drop in 2007. By 2009, volume had decreased slightly, by .1%, while spending increased slightly, by 1.2% but is still below what it was in 2006.
Reductions in federal spending for imaging, some of which has been seen as unnecessary and often duplicative, has been a federal goal since certain payment policies were changed in the Deficit Reduction Act. Reports from the Medicare Payment Advisory Commission and the Congressional Budget Office also have called for reductions in unnecessary federal spending for images.
But AMIC is concerned that the decline in volume of advanced imaging tests "suggests that access issues are at hand," said its executive director, Tim Trysla. "While imaging has been proven to reduce mortality, additional cuts to Medicare reimbursements threaten to continue the current trajectory and further restrict patient access to life-saving diagnostic tools and screening services."
"The implications of these policies may include fewer services available for Medicare beneficiaries, longer wait times, and difficulty in diagnosing patients early, when treatment is most effective," APIC said in a statement.
The Moran Company report also found that mammography screening volumes also decreased by 3% in 2009, compared with a 2.8% compound annual growth rate in the past decade. X-ray absorptiometry (DXA), a measure of bone density, decreased by 2.2% while spending decreased by 16% from 2008-2009.