ACR Chair Tells House Committee Unnecessary and Inferior Medical Imaging Lowers Quality of Care, Costs Taxpayers
March 17, 2005
Contact: Shawn Farley
(703) 648-8936
E-mail: shawnf@acr.org
WASHINGTON – James P. Borgstede, MD, FACR, chair of the American College of Radiology (ACR) Board of Chancellors told the House Ways and Means Subcommittee on Health today that the overuse of medical imaging procedures by less-qualified physicians lowers the quality of patient care, undermines patient safety, threatens the solvency of Medicare, and drains the American health care system of billions of dollars annually.
Borgstede also stated that the ACR supports many of the recent Medicare Payment Advisory Commission (MedPAC) recommendations because current law is not effectively addressing a problem that is both damaging patient care and fleecing American taxpayers.
"We are deeply concerned by the exponential growth in office-based imaging by those who may lack the education, training, equipment, and clinical personnel to safely and effectively use these studies to better their patients' health." Borgstede said. "The real harm is excessive exams and unnecessary exposure to radiation leading to a missed diagnosis, which can result in additional patient injury or even patient death."
Diagnostic radiologists are medical doctors who are required to complete a minimum of 4 to 6 years of post–medical school education in all aspects of medical imaging, including formal training in advanced physics and radiation safety. Other medical specialties, currently performing medical imaging, require a range of imaging education, from as little as 2 days to a maximum of 10 months.
Borgstede also addressed the point that nonradiologist doctors now perform more than half of all nonhospital imaging in the United States. Nonradiologists, who own imaging equipment, are up to 7 times more likely to order diagnostic tests than those who refer patients to a facility in which they have no financial interest.
Diagnostic imaging is now a $100 billion industry in the United States. Imaging is the fastest growing type of physician service expenditure in the United States, with an annual growth rate (9%) that is 3 times that of other physician services.
"Unaccredited, nonradiologist imaging facilities may use poor, perhaps malfunctioning equipment, and employ poorly trained technologists," Borgstede said. "This raises material radiation safety concerns even though the adverse effects of these quality problems may not show up in the form of increased cancer risk, for decades."
Another major concern for the ACR is that poor images taken by lesser-qualified personnel on suboptimal machines can have more of an immediate impact on patient care in terms of increased false positives, which further drain the health system to pursue nonexistent problems and increased false negatives, where missed diagnoses can delay or prevent timely treatment.
"Given the likelihood that Medicare spending on the highest-cost modalities (CT, MRI, PET) may approach $100 billion over the next 10 years, deterring just 5% of projected spending would represent a substantial savings to Medicare and improve care," Borgstede said.
As part of his testimony, Borgstede cited Medicare records that show imaging use by nonradiologists skyrocketed from 1998 to 2003. In Alabama and Ohio, for instance, in-office imaging among nonradiologists was up more than 3,000%—30 times the national average by all providers during that span.
Other examples include Arizona, where imaging by nonradiologists is up as much 1,317%—or 10 times the national average. In Georgia, it's up 503%; Louisiana, up 852%; Minnesota, up 442%; and in Texas, up 1,630%.
Medicare data further show that this disturbing trend is not merely a shift in site of service. Imaging (measured in both number of procedures and dollars per 1000 beneficiaries) has increased significantly in both hospital and office settings since 2000.
Borgstede also noted that inappropriate utilization of medical imaging procedures is a primary driver in escalating insurance costs. Premiums for family health care coverage have risen 59% since 2000, compared with inflation growth of only 9%. American businesses spend, on average, nearly $10,000 per employee for family health care coverage.
"Private insurers who have looked into this issue found a disturbing trend and took steps to clamp down on the practice," Borgstede said. "A recent BlueCross BlueShield study shows nearly a third of imaging performed by nonradiologists to be unnecessary, and another well-regarded study shows that number to be as high as 50%. Unnecessary tests, by definition, may needlessly expose patients to radiation."
The ACR supports many of the MedPAC recommendations that urge Congress to enact laws directing the secretary of Health and Human Services to set quality and safety standards for providers performing medical imaging, physicians interpreting these images, and facilities that bill Medicare for these services.
The ACR also supports the commission's recommendation that Congress include nuclear medicine and PET procedures under existing federal self-referral (Stark) law and tighten other aspects of Stark law dealing with physician ownership.
"The ACR believes these emerging quality problems are the proper focus of policymakers concerned about rising imaging costs. Office-based expansions have been inaccurately justified by such claims as 'patient convenience,' yet convenient access to poor-quality or unnecessary services is hardly a patient benefit. Also, Medicare billing data shows that only 3% of imaging procedures done by nonradiologists are billed on the same claim," Borgstede said. "For these reasons, the ACR supports many of the MedPAC recommendations that Congress link Medicare reimbursement for imaging services to quality, safety, and training standards for the physicians and facilities which provide these services."
###
To arrange an interview with Borgstede or another ACR member, please contact ACR Public Relations Manager Shawn Farley at (703) 648-8936 or shawnf@acr.org.
The ACR is a national professional organization serving more than 32,000 diagnostic radiologists, radiation oncologists, interventional radiologists, nuclear medicine physicians, and medical physicists, with programs focusing on the practice of radiology and the delivery of comprehensive health care services.