ACR Bulletin

Covering topics relevant to the practice of radiology

Proving the Value of Imaging

Celebrating 10 years of research, the Harvey L. Neiman Health Policy Institute® continues to shape health policy through the radiology profession.
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Through this fellowship, we hope to build a pipeline of researchers who will continue to contribute to the mission of the HPI.

—Pina C. Sanelli, MD, MPH, FACR
October 25, 2022

Before the ACR established the Harvey L. Neiman Health Policy Institute® (HPI) in 2012, practice leaders and policymakers had to make decisions about imaging services without knowing how changes would affect individual patients or overall healthcare systems. To connect these dots, the HPI has spent the last decade producing research to help practitioners and policymakers make informed decisions that facilitate access to effective radiologic care, improve patient outcomes, and promote efficiency in the healthcare system.

“At the HPI, our goal is to objectively measure the value radiology is adding to the overall healthcare system, and ensure all patients have access to imaging for screening, diagnosis, and minimally invasive procedures,” says Elizabeth Y. Rula, PhD, executive director of the HPI since 2020. “Our research is a foundation to the future strategy of radiology, paving the way for access and reimbursement that will improve patient care.”

Through collaborative research, self-service data tools, academic training, and other outreach, the HPI provides credible resources to guide imaging practices and policies forward as healthcare
rapidly evolves. In part two of a three-part series celebrating the HPI’s 10 years of research and excellence, the Bulletin dives into the HPI’s external-facing work and how it impacts the radiology community, keeps policymakers and other stakeholders informed with evidence, and ensures the HPI is positioned for the future.

Shaping Future Policies

Researchers at the HPI work closely with radiologists, lawmakers, academic and economic leaders, and other stakeholders to set strategic research priorities relevant to the changing times. The team has worked with more than 92 unique authors in over 35 institutions. These studies are regularly published in peer-reviewed journals, typically 30 per year, which are picked up by the press, expanding the HPI’s impact far beyond the ACR.

“All of our research is collaborative,” Rula says. “We involve a wide range of stakeholders to ensure that we understand what radiologists and policymakers are concerned about, so we can build our research agenda to directly address those issues.”

Generally, the HPI pursues five research themes: payment models, imaging value propositions, practice advancement, workforce development, and health equity. In addition to these pillars, the HPI examines pressing issues like the CT contrast shortage and reduced mammography screening utilization due to COVID-19-related shutdowns, offering mitigation strategies to help radiology practices adapt to current and coming challenges.1,2

“We’re able to quickly respond to emerging issues to ensure that radiology can be well-positioned to add value in these new healthcare paradigms,” Rula says. “We balance these urgent needs with our proactive research agenda to address the big issues up the road.”

Assessing Healthcare Costs

To access additional expertise and ensure objectivity, the HPI established academic research centers like the Health Economics and Analytics Lab (HEAL) at the Georgia Institute of Technology’s
School of Economics, and the Policy Research and Imaging Effectiveness (PRIME) Center inside the Institute of Health System Science at the Feinstein Institutes for Medical Research at Northwell Health. These research partners support the HPI’s mission to generate evidence-based imaging recommendations to inform health policy and improve population health.

“The focus of the PRIME Center is to demonstrate the value of imaging by assessing the health benefits and costs associated with radiology services,” says Pina C. Sanelli, MD, MPH, FACR, director of the NHPI PRIME Center since it opened in 2018. “We study new imaging technology and perform cost-effectiveness analyses to show how much it would cost to improve health outcomes.”

For example, the PRIME Center assessed the costs, benefits, and trade-offs between comprehensive and stepwise imaging for acute stroke patients.3 The research revealed that comprehensive
imaging strategies yield better health outcomes, and comprehensive CT provides the most cost-effective approach.

“The research we generate provides the evidence that shapes the guidelines and recommendations for how we practice medicine, and that drives policy decisions,” Sanelli says. “The cost of care becomes incredibly important when changing policies, so part of our mission is to help policymakers understand the costs while focusing on improving patient outcomes.”

We involve a wide range of stakeholders to ensure that we understand what radiologists and policymakers are concerned about, so we can build our research agenda to directly address those issues.

—Elizabeth Y. Rula, PHD

Leveraging National Data

Conducting objective research is only part of the HPI’s legacy. The other piece is translating and sharing these insights through scientific articles as well as robust online data tools — like the Neiman Almanac which aggregates years of information from various sources and provides more than 100 data series within the tool.

“For years, there was a lack of reliable national data about imaging economics and radiology utilization,” says Shawn Farley, director of public affairs for the ACR. “That information didn’t exist — or if it did, it was hard to find. The HPI has been a godsend because it makes it easy to get accurate information to providers, reporters, and the public. We can link directly to the data, so it’s easily consumable by people who are not researchers or doctors.”

The HPI has access to national Medicare and private payer data dating back to 2004. “This allows us to see trends over time, understand the impact of policy change, and project what’s coming
in the future,” Rula says. “Having these huge data sets allows us to not only answer questions at the national level, but also to drill down and understand factors influencing health locally at the community level.”

Committed to continually enhancing these data assets, the HPI is acquiring claims datasets from Medicaid and the Children’s Health Insurance Program (CHIP) that will contain 100% of beneficiary claims from 2018 and 2019. “This data will generate new insights to drive policy decisions for these often-underserved populations and help us understand the impact of state Medicaid policies,” Rula says. “It’s very exciting.”

Funding Future Research

To foster novel research from future radiology leaders, the HPI also facilitates the Neiman Institute Grants Program. Two grants are awarded annually to radiology research topics that align with the institute’s mission, focusing on areas like AI and emerging technology, emerging payment and population health models, and practice advancements. The current grant application cycle closes on Nov. 8.

Last year, the HPI also established a fellowship through the PRIME Center with the goal of training young radiologists interested in health services and policy research. What makes the fellowship unique, Sanelli says, is that it combines these research disciplines into a single experience, supported by mentorship.

“It’s important to foster the research interest and skills of early-career radiologists. Through this fellowship, we hope to build a pipeline of researchers who will continue to contribute to the mission of the HPI,” says Sanelli, who oversees the program. “The fellow learns how to demonstrate the value of imaging technology and understand its impact, providing evidence that will inform health policy and radiology practice.”

Creating a Legacy

Just 10 years since its formation, the HPI is already advancing the role of imaging in the health system. As an ACR board member once told Rula, “The HPI is a crown jewel of the ACR,” because it adds value to the profession far beyond the reading room.

Rather than looking back at the last 10 years of accomplishments, the HPI’s leaders and partners are looking to the future as they equip stakeholders with the research to move medicine forward.

“The Neiman Institute importantly raises awareness of imaging evidence to a variety of stakeholders who influence the future of healthcare delivery, including the policymakers who are making the recommendations and the radiologists and healthcare leaders who are implementing the recommendations,” Sanelli says. “This is important in ensuring that future imaging policies actually benefit patients.”


  1. An Empiric Medicare Claims-Based Utilization Approach to Mitigating the Iodinated Contrast Shortage, Journal of the American College of Radiology, May 25, 2002.
  2. Impact of the COVID-19 Pandemic on Breast Imaging: An Analysis of the National Mammography Database, Journal of the American College of Radiology, August 2022.
  3. Cost-Effectiveness Study of Initial Imaging Selection in Acute Ischemic Stroke Care, National Library of Medicine, National Center for Biotechnology Information.

Author Brooke Bilyj  freelance writer, ACR Press