Top

Published in:

01-04-2017 | Magnetic Resonance Imaging

Diagnostic imaging and spending review: extreme problems call for extreme measures

Authors: Anna Micaela Ciarrapico, Rossana Ugenti, Lidia Di Minco, Elisabetta Santori, Simone Altobelli, Irene Coco, Silvia D’Onofrio, Giovanni Simonetti

Published in: La radiologia medica | Issue 4/2017

Abstract

The number of diagnostic imaging tests has increased dramatically over the past decade and about 5 billion diagnostic examinations are performed worldwide each year. According to Health Ministry, Italy, is in second place for the number of CT and MR tests per thousand inhabitants in 2014 with a score of 83.3 (only Germany has a higher score, 95.2) that is a long way off from the European average of 46.5. It has also the highest ratio of magnetic resonances per person with 24,6 machines per million inhabitants, followed only by Greece and Finland. The development of the New Health Information System (NSIS) in 2010 made uniformly readable the non-homogeneous clinical data from all the different Italian regions and permitted a detailed analysis of all diagnostic imaging within the public outpatient care setting in Italy in 2012. Despite that MRI examinations represented only the 10% of the total number of imaging tests performed, their cost reached 30% of the health-care expenditure for outpatient diagnostic imaging with an overwhelming contribution coming from musculoskeletal MR which accounted for the 73% of the performed MR tests. It is reasonable to assume that these phenomena are likely due to a lack of appropriateness in MR requests that is difficult to analyze due to an absence or invalid query on the prescriptions which together accounted for the 98.7% of cases. Taking into account the above-mentioned situation, this is possibly why the Ministry of Health decided to perform “linear cuts” in expenditure for some diagnostic examinations.

Smith-Bindman R, Miglioretti DL, Larson EB (2008) Rising use of diagnostic medical imaging in a large integrated health system. Health Aff (Millwood) 27(6):1491–1502CrossRef

Beinfeld MT, Gazelle GS (2005) Diagnostic imaging costs: are they driving up the costs of hospital care? Radiology 235(3):934–939CrossRefPubMed

Agarwal R, Bergey M, Sonnad S, Butowsky H, Bhargavan M, Bleshman MH (2010) Inpatient CT and MRI utilization: trends in the academic hospital setting. J Am Coll Radiol. 7(12):949–955CrossRefPubMed

Chan KS, Chang E, Nassery N, Chang HY, Segal JB (2013) The state of overuse measurement: a critical review. Med Care Res Rev 70(5):473–496CrossRefPubMed

Squires D, Anderson C (2015) U.S. health care from a global perspective: spending, use of services, prices, and health in 13 countries. Issue Brief (Commonw Fund) 15:1–15

Fortino A, Miceli M, Filogna M, Fadda A (2010) FA-RE: un valido sistema di raggruppamento per classificare ed analizzare le prestazioni specialistiche ambulatoriali. QA 20(3):100–106

Lang K, Huang H, Lee DW, Federico V, Menzin J (2013) National trends in advanced outpatient diagnostic imaging utilization: an analysis of the medical expenditure panel survey, 2000-2009. BMC Med Imaging 13:40CrossRefPubMedPubMedCentral

Levin DC, Rao VM, Parker L (2012) Trends in the utilization of outpatient advanced imaging after the deficit reduction act. J Am Coll Radiol 9(1):27–32CrossRefPubMed

Levin DC, Rao VM, Parker L, Frangos AJ, Sunshine JH (2011) Bending the curve: the recent marked slowdown in growth of noninvasive diagnostic imaging. AJR Am J Roentgenol 196(1):W25–W29CrossRefPubMed

10.

Levin DC, Rao VM, Parker L (2010) Physician orders contribute to high-tech imaging slowdown. Health Aff 29(1):189–195CrossRef

11.

Levin DC, Rao VM, Parker L (2015) Trends in outpatient MRI seem to reflect recent reimbursement cuts. J Am Coll Radiol 12(5):463–466CrossRefPubMed

12.

Pincus T (1993) A pragmatic approach to cost-effective use of laboratory tests and imaging procedures in patients with musculoskeletal symptoms. Prim Care 20(4):795–814PubMed

13.

Lehnert BE, Bree RL (2010) Analysis of appropriateness of outpatient CT and MRI referred from primary care clinics at an academic medical center: how critical is the need for improved decision support? J Am Coll Radiol 7(3):192–197CrossRefPubMed

14.

Jame SZ, Sari AA, Majdzadeh R, Rashidian A, Arab M, Rahmani H (2014) The extent of inappropriate use of magnetic resonance imaging in low back pain and its contributory factors. Int J Prev Med 5(8):1029–1036PubMedPubMedCentral

15.

Roberts TT, Singer N, Hushmendy S, Dempsey IJ, Roberts JT, Uhl RL, Johnson PE (2015) MRI for the evaluation of knee pain: comparison of ordering practices of primary care physicians and orthopaedic surgeons. J Bone Joint Surg Am 97(9):709–714

16.

Karel YH, Verkerk K, Endenburg S, Metselaar S, Verhagen AP (2015) Effect of routine diagnostic imaging for patients with musculoskeletal disorders: a meta-analysis. Eur J Intern Med 26(8):585–595CrossRefPubMed

17.

Gazelle GS, Halpern EF, Ryan HS, Tramontano AC (2007) Utilization of diagnostic medical imaging: comparison of radiologist referral versus same-specialty referral. Radiology 245(2):517–522CrossRefPubMed

18.

Hillman BJ, Joseph CA, Mabry MR, Sunshine JH, Kennedy SD, Noether M (1990) Frequency and costs of diagnostic imaging in office practice–a comparison of self-referring and radiologist-referring physicians. N Engl J Med 323(23):1604–1608CrossRefPubMed

19.

Cristofaro M, Busi Rizzi E, Schininà V, Chiappetta D, Angeletti C, Bibbolino C (2012) Appropriateness: analysis of outpatient radiology requests. Radiol Med 117(2):322–332CrossRefPubMed

20.

Web page of Choosing wisely project available at http://http://www.slowmedicine.it

21.

Colla CH, Morden NE, Sequist TD, Schpero WL, Rosenthal MB (2015) Choosing wisely: prevalence and correlates of low-value health care services in the United States. J Gen Intern Med 30(2):221–228CrossRefPubMed

Title: Diagnostic imaging and spending review: extreme problems call for extreme measures
Authors: Anna Micaela Ciarrapico
Rossana Ugenti
Lidia Di Minco
Elisabetta Santori
Simone Altobelli
Irene Coco
Silvia D’Onofrio
Giovanni Simonetti
Publication date: 01-04-2017
Publisher: Springer Milan
Published in: La radiologia medica / Issue 4/2017
Print ISSN: 0033-8362
Electronic ISSN: 1826-6983
DOI: https://doi.org/10.1007/s11547-016-0721-7

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Diagnostic imaging and spending review: extreme problems call for extreme measures

Abstract

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Please log in to get access to this content

Other articles of this Issue 4/2017

Gd-EOB-DTPA-enhanced MRI T1 mapping for assessment of liver function in rabbit fibrosis model: comparison of hepatobiliary phase images obtained at 10 and 20 min

1H- and 31P-myocardial magnetic resonance spectroscopy in non-obstructive hypertrophic cardiomyopathy patients and competitive athletes

Noise-optimized monoenergetic post-processing improves visualization of incidental pulmonary embolism in cancer patients undergoing single-pass dual-energy computed tomography

Late toxicity, evolving radiotherapy techniques, and quality of life in nasopharyngeal carcinoma

A critical appraisal of endovascular stent-grafts in the management of abdominal aortic aneurysms

Multidetector CT findings of histopathologically proven peritoneal tuberculous cold abscesses