Necessity, Efficacy Of Medical Imaging Questioned As Number Of Scans Ordered Rises

Main Category: MRI / PET / Ultrasound
Also Included In: Radiology / Nuclear Medicine;  Primary Care / General Practice
Article Date: 03 Mar 2009 - 3:00 PDT

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The New York Times on Monday examined several issues surrounding the quickly growing medical imaging industry. More than 95 million "high-tech scans" are done annually, including computed tomography, magnetic resonance imaging and position emission tomography scans, the Times reports. Medical imaging has "ballooned into a $100-billion-a-year industry" in the U.S., with Medicare paying $14 billion of this total, according to the Times. However, recent studies suggest that as many as 20% to 50% of these scans should not have been done, because they did not help diagnose ailments or treat patients, the Times reports.

In addition, because the field of medical imaging is "largely unregulated," insurers have no way of knowing whether they are paying for good quality scans, according to America's Health Insurance Plans. Medical experts say that poor-quality scans are a "growing problem with medical imaging," according to the Times. The Times reports that scanning equipment covers a broad range of age and quality but insurers pay the same for scans no matter the machine used. According to the Times, the only way insurers can detect poor quality scans is by noticing frequent requests to redo scans at certain facilities.

Although imaging centers can become accredited by the American College of Radiology, many centers provide scanning services without being accredited. The percentage of those certified by ACR is not known because there is no national registry of imaging centers. A law that was passed last year and is set to take effect in 2012 will require that Medicare only pay for scans done at accredited centers. However, even with this rule "there is still little assurance" that scans will be ordered and interpreted appropriately or that the scanner used will be up to date, the Times reports.

Another issue is that physicians often refer patients to imaging centers that they "own and profit from," the Times reports. The Government Accountability Office in a recent report stated that two-thirds of Medicare payments for imaging are for scans done in physicians' offices. The report also found that doctors are receiving a larger portion of their income from scanning services. Studies have shown that doctors are up to 3.2 times more likely to order a scan when it can be done at their office or a center that they profit from. GAO wrote, "No comprehensive national standards exist for services delivered in physician offices other than a requirement that imaging services are to be provided under at least general physician supervision" (Kolata, New York Times, 3/2).

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