Utilization in mind

Two studies examining imaging utilization made our top story list this week, one that painted a familiar picture of imaging’s growth and retraction, while the other offered an important reminder about the factors behind imaging use.

Researchers from Brigham and Women’s Hospital in Boston examined imaging utilization by their emergency department (ED) for a study published in the American Journal of Roentgenology. Reviewing ED radiology utilization from 1993 through 2012, they found a decade-long rise in utilization came to an end around 2007, when usage rates of CT and MRI began declining. During the growth period, CT relative value units increased 493 percent, while MRI RVUs increased 2,475 percent. Between 2007 and 2012, though, CT declined 33.4 percent and MRI declined 20.6 percent.

The trends in the ED imaging study mirror previous analyses about imaging trends overall: a precipitous rise in imaging use through the late 1990s and early 2000s, which plateaus and begins to retract in the late 2000s to today.

Many factors contributed to the end of imaging growth. CT and MRI technology matured past their explosive growth phases, and initiatives to curb unnecessary imaging due to a greater awareness of radiation and spending concerns have certainly slowed utilization rates. But another study out this week offers a reminder that some forces behind utilization are not necessarily in provider’s hands.

Looking at disparities in imaging use for acute ischemic stroke, researchers from the Mayo Clinic in Rochester, Minn., found that privately insured patients were more likely to receive noninvasive head and neck angiography, head MRI and echocardiography compared with the uninsured or patients on public insurance. The study couldn’t definitively explain the underlying causes, but the authors suggested that insurance status correlated with the type of hospital where care is sought and also with the likelihood that stroke symptoms would be recognized.

While much discussion about imaging utilization within the field has focused on adherence to guidelines and reducing unnecessary scans, it’s important to remember the impact of factors outside the radiologist’s control. An understanding of how insurance status affects utilization is vital considering recent reforms are extending coverage to millions more in the U.S., while at the same time, the population is aging and more people will be seeking care.

This doesn’t mean radiology should be less concerned about factors within the specialty that affect utilization. Just the opposite. Imaging professionals need to make sure their processes and systems are optimized to ensure all imaging is appropriate knowing a growing number of patients are coming their way.

-Evan Godt
Editor – Health Imaging