Some repeat imaging might occur within the parameters of acceptable practices and medical necessity and shouldn’t be identified as waste
Many health plans are applying utilization management tools to medical imaging benefits to reduce costs and cut unnecessary use. However, today’s benchmarks on imaging are likely not specific enough.
The Harvey L. Neiman Health Policy Institute (HPI) in Reston, Va., recently released a policy brief to classify types of repeat imaging and identify opportunities to cut waste without negatively impacting care. Authors note that some repeat imaging might occur within the parameters of acceptable practices and medical necessity and shouldn’t be identified as waste.
“One needs to drill down and look at all the additional information that is available,” says Richard Duszak, MD, chief executive officer and senior research fellow of HPI, and one of the authors of the repeat imaging report. “Most of the time what we are constrained with at the population level are ICD-9 codes.”
Dr. Duszak says as the industry moves toward big data, researchers can study encounter data at a more granular level to examine not only what type of imaging was done but why it was ordered by the clinician. Sophisticated EHRs, he says, will help “get beyond the ‘what’ and get to the ‘why.’”
If researchers do not consider the clinical context of a particular test, unintended consequences for individual patients and the system overall could result as the system seeks cost-containment solutions. HPI recommends a classification system for repeat imaging for use in research and analysis.
Supplementary Imaging-Could occur during the same or overlapping encounter involving a different method, for example, a CT scan followed by a renal ultrasound for a patient with a possible kidney stone.
Duplicate Imaging-Could occur during the same or overlapping encounter involving the same method, for example, a repeat CT scan is performed when an acute patient’s condition deteriorates.
Follow-up Imaging-Could occur during a subsequent, related encounter involving the same or a different method, for example, a patient previously treated for cancer might require repeat imaging to survey possible recurrence.
Unrelated Imaging-Could occur during a subsequent encounter involving the same or a different method, for example, a patient undergoes a CT scan for breast cancer then a short time later undergoes another CT scan after a motor vehicle accident.
Authors recommend that researchers precisely define methodology in the clinical context for any study of repeat imaging. In many cases, clinical data, rather than administrative data, would be needed.