One size does not fit all when it comes to imaging use, so it makes sense that it’s not a fit for utilization optimization, either. Indeed, a recent study suggests a targeted approach to managing imaging utilization could be more effective than a national intervention.
In “Use of Public Data to Target Variation in Providers’ Use of CT and MR Imaging among Medicare Beneficiaries” (February 5, Radiology), a team of authors led by Dr. Ivan Ip examined geographic trends in imaging referrals. They found a wide variation in use, ranging from 330 studies per 1,000 beneficiaries to 684 per 1,000. The research team used a pair of public CMS databases to assess 124 million diagnostic imaging services provided to Medicare beneficiaries in 2012.
“Although national campaigns and federal policy changes may enable broad system-level improvement, our results suggest that more targeted interventions, focusing on providers that order and/or perform the most common procedures in the highest impact regions, may more efficiently promote needed change,” they write.
Another recent article said recommendations against imaging for headaches could cause undiagnosed brain tumors to be missed. Dr. Ammar Hawasli of the Washington University School of Medicine in St. Louis worries that proposed population-based regulation on medical imaging utilization could lead to negative outcomes for patients who present with headaches as their only symptom.
Hawasli and his team reviewed presenting symptoms and preoperative histories of 95 patients diagnosed with brain neoplasms through the use of open-brain biopsies. Eleven of the patients presented with headaches only, and the authors determined that the tumors would have been missed in three to seven of those patients using the Choosing Wisely neuroimaging guidelines being proposed.
In an article in HealthImaging, editor Evan Godt says these stories are proof of the dangers of taking too broad of an approach to utilization optimization. We certainly agree, but we see an even bigger message here. Rather than sweeping pronouncements, what we need is a thoughtful, agile move away from traditional imaging models toward strategic, value-based imaging departments.
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