Health Affairs, 27, no. 6 (2008): 1466 doi: 10.1377/hlthaff.27.6.1466 © 2008 by Project HOPE	New Online   Senate Health Reform Bill   Rewarding Providers   Public Option Policy Brief   Health Reform & Abortion   Delivery System Reform

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Imaging Boom

PROLOGUE

The Imaging Boom

Nationwide, an estimated twenty-six million MRIs are now performed annually—on average, more than 173 for each and every Medicare beneficiary. Each additional machine drives the number of procedures upward; every new CT unit, for example, averaged more than 2,200 new procedures per year in 1995–2004.

This imaging boom raises myriad critical questions for patients, providers, and payers—many of them clustered around the topic of whether we’re getting enough value for the dollars spent. Are these technologies overused or appropriately used—and under what circumstances, for which patients? How much imaging should we perform and pay for if the main benefit is additional information—for example, learning that you don’t have a brain tumor—and not necessarily quantifiable improvements in real health outcomes? Are payers like Medicare overcompensating providers for doing these scans? What should be done about the apparent conflicts of interest inherent in physicians’ having their own in-office advanced imaging equipment, since each additional CT unit in a physician’s practice is associated with about $685,000 in additional spending per year?

The authors of the papers in this section explore these questions in depth. Ariel Winter and Nancy Ray analyze Medicare’s considerations in deciding how much to pay; they conclude that flaws in those formulas could be fueling the imaging boom. Steven Pearson and colleagues describe challenges in evaluating imaging’s comparative effectiveness, given such factors as rapid changes in imaging techniques and differences in providers’ diagnostic skills. They produce a case study of CT colonography, commonly known as "virtual colonoscopy," and tell how their group at Massachusetts General Hospital’s Institute for Clinical and Economic Review evaluated such factors as radiation risk. They also offer perspective on how evidence reviewers can better assess these technologies going forward.

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