The Uncritical Use of High-Tech Medical Imaging

Increased Emergency Department Computed Tomography Use for Common Chest Symptoms Without Clear Patient Benefits

“…23 A 2004 Intersociety of Radiology summary report on inappropriate ordering suggests that increased utilization is likely secondary to poor understanding of what study is needed, high public expectations, medical liability issues, and self referral. 24 Subsequent studies largely have confirmed this opinion because patient self referral, 25 the style and content of clinical education, 26 and the fear of malpractice litigation 27 have been shown to contribute to increased ordering. Somewhat troubling with regard to public expectations and self referral of patients is that an increasing number of diagnostic imaging studies, including CT scan, have transitioned from inpatient settings to outpatient centers and specialty hospitals.…”

Physical Therapist Practice and the Role of Diagnostic Imaging

“…33 Factors such as physician selfreferral, an incomplete evidence basis for the use of imaging, a patient's desire for imaging, a physician's concern over liability risk, and even the manner in which medical students are educated may lead to overutilization. 1,33,34 Recently, the Medicare Payment Advisory Committee (MedPAC) found that between 2002 and 2007, imaging services increased 45% per beneficiary, whereas evaluation and management services increased less than 15%. 41 MedPAC warns that such overuse threatens the long-term sustainability of the Medicare program.…”

“…31 Physical therapy education should follow the recommendations for physician training in imaging, with an emphasis on when to request for imaging, how to identify the appropriate imaging modality, and how to consult a radiologist. 34 The importance of effective communication with radiological professionals (radiologists and technicians), as well as other physicians, regarding the need for imaging, rather than concentrating on interpretation, is highlighted. Performing or interpreting images for a definitive diagnostic purpose has never been the objective of these courses.…”

Accountable Care Organizations

“…The absence of incentives to alter practice is associated with very high health costs (with health expenditures anticipated to rise to 20% of the gross domestic product by 2019) 6 and evidence of inappropriate use of resources. [7][8][9][10] The legislation creating ACOs as part of the ACA is hardly the first time that Congress has engaged in delivery reform efforts aimed at holding a single entity financially responsible for its patients across the care continuum. The Health Maintenance Organization Act of 1973 (hereafter, HMO Act) and the rise of managed care entities participating in Medicare and Medicaid directly contributed to greater financial and clinical integration of health-care delivery in the early 1990s.…”