Advanced Diagnostic Imaging in Privately Insured Patients: Recent Trends in Utilization and Payments

Horný, Michal; Burgess, James; Horwitt, Jedediah; Cohen, Alan B.

doi:10.1016/j.jacr.2014.01.019

Cited by 16 publications

(17 citation statements)

References 5 publications

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“…Several studies have documented a slowdown in utilization of advanced diagnostic imaging between 2008 and 2011 in the Medicare Part B fee-for-service population [4][5][6][7][8]. In 2014, we published a study [9] examining trends in utilization of and payments for advanced diagnostic imaging for the 2007 to 2011 period in a population of commercially insured individuals. As found in the Medicare Part B population studies, we observed declining patterns in both utilization and payments until 2010, but another increase occurred in 2011.…”

Section: Introductionmentioning

confidence: 99%

“…The current article describes a follow-up study, using the most recent data from 2012 and 2013 to investigate whether the increased utilization of advanced diagnostic imaging in privately insured patients in 2011 was the beginning of a new growth trend or an isolated deviation from the declining trend that began around 2008. As in our previous study [9], we explored trends in utilization of and payments for four diagnostic imaging modalities-CT, diagnostic ultrasound, MRI, and PET-in a commercially insured population in the United States.…”

Section: Introductionmentioning

confidence: 99%

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Advanced Imaging Utilization Trends in Privately Insured Patients From 2007 to 2013

Horný

Burgess

Cohen

2015

Journal of the American College of Radiology

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Advanced Imaging Utilization Trends in Privately Insured Patients From 2007 to 2013

Horný

Burgess

Cohen

2015

Journal of the American College of Radiology

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“…By agreement with our local payers, orders submitted though the radiology order entry system were automatically approved for payment, so the clinicians in our system did not engage with radiology benefits management companies except for the small fraction (3%-5%) of primary care patients covered by large national commercial payers. The program also involved regular provision of reports showing rates of high-cost imaging utilization and order (2,3,5,(7)(8)(9)(10). Patients and physicians flow into and out of the associated datasets in such studies in constantly changing and uncontrolled ways.…”

Section: Discussionmentioning

confidence: 99%

“…Various imaging utilization management (UM) efforts designed to control the costs of high-cost imaging were introduced during this period. The rate of growth of high-cost imaging utilization began to slow in the late 2000s and appeared to be small to nearly flat by 2010 (2)(3)(4)(5)(6).…”

Section: Implications For Patient Carementioning

confidence: 99%

Utilization Management of High-Cost Imaging in an Outpatient Setting in a Large Stable Patient and Provider Cohort over 7 Years

et al. 2017

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Purpose To quantify the effect of a comprehensive, long-term, provider-led utilization management (UM) program on high-cost imaging (computed tomography, magnetic resonance imaging, nuclear imaging, and positron emission tomography) performed on an outpatient basis. Materials and Methods This retrospective, 7-year cohort study included all patients regularly seen by primary care physicians (PCPs) at an urban academic medical center. The main outcome was the number of outpatient high-cost imaging examinations per patient per year ordered by the patient's PCP or by any specialist. The authors determined the probability of a patient undergoing any high-cost imaging procedure during a study year and the number of examinations per patient per year (intensity) in patients who underwent high-cost imaging. Risk-adjusted hierarchical models were used to directly quantify the physician component of variation in probability and intensity of high-cost imaging use, and clinicians were provided with regular comparative feedback on the basis of the results. Observed trends in high-cost imaging use and provider variation were compared with the same measures for outpatient laboratory studies because laboratory use was not subject to UM during this period. Finally, per-member per-year high-cost imaging use data were compared with statewide high-cost imaging use data from a major private payer on the basis of the same claim set. Results The patient cohort steadily increased in size from 88 959 in 2007 to 109 823 in 2013. Overall high-cost imaging utilization went from 0.43 examinations per year in 2007 to 0.34 examinations per year in 2013, a decrease of 21.33% (P < .0001). At the same time, similarly adjusted routine laboratory study utilization decreased by less than half that rate (9.4%, P < .0001). On the basis of unadjusted data, outpatient high-cost imaging utilization in this cohort decreased 28%, compared with a 20% decrease in statewide utilization (P = .0023). Conclusion Analysis of high-cost imaging utilization in a stable cohort of patients cared for by PCPs during a 7-year period showed that comprehensive UM can produce a significant and sustained reduction in risk-adjusted per-patient year outpatient high-cost imaging volume. RSNA, 2017.

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“…6 Advanced imaging technologies-computed tomography (CT), MRI, and positron emission tomography (PET)-have been drivers of rapid growth in healthcare spending over the past two decades. 7,8 Although noninvasive imaging has enormous benefits, it also has adverse impacts such as cumulative radiation exposure and a potential cascade of invasive, but ultimately negative, diagnostic procedures. Gold et al traced the timeline for adoption of breast imaging technologies, considering the chronology of peer-reviewed journal articles, FDA clearance or approval for marketing, insurance reimbursement, and incorporation into clinical practice guidelines.…”

Section: Lessons Learned or "Déjà Vu All Over Again?"mentioning

confidence: 99%

Making personalized medicine more affordable

Aronson

2015

Annals of the New York Academy of Sciences

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Precision medicine holds promise to solve the conundrums of clinical care. Foremost is the well-known but vexing problem of heterogeneity and the tyranny of the mean. Who will respond to a treatment? How can patients avoid the harms of treatments that will not work for them? And if we know who to treat, will that make care more efficient and less costly? But the converse can also be true: treatments become more expensive as the costs of development must be distributed across smaller populations. Next-generation sequencing is making genetic testing radically cheaper. But the costs of medical tests also include false-positive results, incidental findings, and the cascade of follow-up. The affordability of precision medicine is intertwined with the broader issue of affordability of our healthcare system, and will require all stakeholders to assume stewardship for access and sustainability.

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Advanced Diagnostic Imaging in Privately Insured Patients: Recent Trends in Utilization and Payments

Cited by 16 publications

References 5 publications

Advanced Imaging Utilization Trends in Privately Insured Patients From 2007 to 2013

Advanced Imaging Utilization Trends in Privately Insured Patients From 2007 to 2013

Utilization Management of High-Cost Imaging in an Outpatient Setting in a Large Stable Patient and Provider Cohort over 7 Years

Making personalized medicine more affordable

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