The 130th Annual Meeting of APHA

Abstract #37316

Jonathan Sunshine, PhD, Research, American College of Radiology, 1891 Preston White Dr., Reston, VA 20191, 703-648-8924, jonathans@acr.org, Mythreyi Bhargavan, PhD, Research Dept., American College of Radiology, 1891 Preston White Dr., Reston, VA 20191, and Christopher Hogan, PhD, Direct Research LLP, 506 Moorefield Rd, SW, Lower Level, Vienna, VA 22180.

PURPOSE: See statement of purpose. METHOD: We track trends in utilization of radiologic imaging, measured in relative value units, per age-, sex-, and risk-standardized Medicare beneficiary for 1986-98. RESULTS: Overall, radiologic imaging per standardized beneficiary increased 126%, a compound annual rate of increase (CARI) of 7.0%, far higher than for health care in general. Omitting the old, "low-tech" modality of X-rays and fluoroscopy, the CARI was 10.2%. There were major differences by physician specialty. The CARI for imaging performed by cardiologists was 23%, with their share of total imaging increasing from 5% to 25%. The CARI for radiologists was 4.4%; their share fell from 79% to 59%. For all others, the CARI was 7.2%. Cardiac imaging procedure groups (coronary angiography, echocardiography, and cardiac nuclear medicine) had a combined CARI of 18%, with the CARI for each procedure group at least 15%. For X-rays and fluoroscopy, the CARI was 1.4%. For all non-cardiac high-tech imaging (including CT and MRI), the CARI was 7.3%. Finer disaggregation shows similar patterns. For example, the CARI for cardiac nuclear medicine performed by cardiologists was 27%; for cardiac nuclear medicine performed by radiologists, it was 9.7%. CT and MRI, the high-tech modalities most in the public's mind, had a combined CARI of 8.6%. For MRI, a technology just being introduced in 1986, the CARI was 25%; for CT, it was 6.1%. CONCLUSION: High-tech imaging is growing rapidly, with the growth concentrated among non-imaging-specialist physicians (that is, non-radiologists), particularly cardiologists, and in cardiac imaging. The relatively modest growth of CT indicates MRI is to some extent substituting for it, as is widely believed. In contrast, all types of cardiac imaging grew very rapidly, suggesting there was no replacement of older technologies by newer ones. IMPLICATIONS: An extensive literature shows that non-radiologists who do their own imaging generate multiples as much imaging as physicians in the same specialty seeing patients with the same problems, but sending their patients to radiologists for imaging. Our study shows this phenomenon occurring on the most macro scale. Payers should consider remediation. On the other hand, the cardiac disease death rate is falling substantially, and studies of appropriateness of cardiac imaging often find more underutilization than overutilization. Probably, the issue to address--an issue not typically addressed by appropriateness studies--is: If several imaging procedures are, individually, appropriate for a patient, how many of them actually should be performed?

Learning Objectives: At the end of the session, attendees should be able to

• Identify the types of imaging and physician specialties for which imaging growth has been most rapid.
• Describe how those concerned about costs, such as insurers, might address the growth with suitable attention to appropriateness of care

Keywords: Cost Issues, Quality of Care

Presenting author's disclosure statement:
Organization/institution whose products or services will be discussed: none
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.