After the deluge: MR use rates dip from 2008 peak

After years of growth, the utilization rate for MR exams in the Medicare population fell 3.2 percent between 2008 and 2010, according a study published in the August issue of the Journal of the American College of Radiology.

“Recent studies have found that some advanced imaging modalities, such as CT and nuclear medicine, saw decreases in overall utilization between 2008 and 2010. This study documents a similar trend in MR,” wrote Richard E. Sharpe Jr., MD, MBA, Thomas Jefferson University Hospital and Jefferson Medical College, Philadelphia, and colleagues.

This trend was revealed by an analysis of Medicare Part B data for all MR exams performed in the Medicare population from 1998 through 2010. The researchers used CPT codes to tabulate MR utilization for each year of the study period and categorize MR volume by body system.

Rate of MR use in the Medicare population was 73 per 1,000 beneficiaries in 1998 and increased to 189 per 1,000 in 2008, representing a compound annual growth rate of 10 percent over this period, according to the authors. The rate decreased to 183 per 1,000 in 2010.

More than 2.4 million MR exams were ordered in 2010. The head was the most frequently imaged body section, with head MRI representing 37.3 percent of the total exam volume. Spine MR accounted for another 34.8 percent.

In speculating as to what has caused the downswing in MR utilization, Sharpe and colleagues offered a list of potential factors, including:

• The global recession;
• Concerns over excessive healthcare expenses; and
• Efforts by radiologists to encourage appropriate use of imaging among their colleagues.

“[T]here has been an increase in public awareness of, and perhaps the unnecessary use of, advanced medical imaging,” wrote the authors. “Several articles in the news media have focused on the increased cost, inconvenience, and radiation exposure of unnecessary medical imaging. Anecdotally, we are aware of patients refusing to obtain tests that they feel are not necessary. Perhaps more than in the past, patients today want to know, ‘Do I need this test?’ before undergoing advanced medical imaging.”

Since rapid innovation in medical imaging could make it challenging for physicians to determine the most appropriate use of imaging, Sharpe and colleagues called out a few initiatives to help guide imaging utilization. The American College of Radiology Appropriateness Criteria, the Image Wisely campaign, and the Choosing Wisely initiative are all sources of information about which settings are appropriate for imaging and which tests are often ordered unnecessarily.