Use of Diagnostic Imaging Falls Off, with Exception of Ultrasound.
Outpatient use of advanced diagnostic-imaging tests such as MRIs declined in 2013 after earlier increases, with the exception of ultrasound tests, which continued to climb, a new study led by School of Public Health researchers shows.
The study in the Journal of the American College of Radiology found that the trend of increasing use of such imaging “seems to be over for some, but not all, imaging modalities” among privately insured patients. Outpatient utilization of CT scans and PET scans decreased between 2011 and 2013, while use of MRIs fell off in 2013 after climbing from 2010 to 2012.
In contrast, a rise in obstetric ultrasound procedures was largely responsible for what the authors called a “striking, consistent rise” in outpatient ultrasound use between 2011 and 2013.
The researchers speculated that the decline in CT scans in both outpatient and inpatient settings may have been influenced by an increased awareness of harms resulting from radiation exposure. They cited the ABIM Foundation’s Choosing Wisely initiative, an effort started in 2012 to discourage unnecessary medical tests, treatments, and procedures.
The uptick in ultrasounds is likely linked to technology advances, policy changes, and easy access for privately insured patients, the authors said. They cited the increasing use of breast ultrasound to supplement mammography, noting that some states have adopted breast-density notification laws requiring physicians to inform patients who have dense breast tissue about the limitations of mammography.
The research team, using a national sample of more than 35 million health insurance beneficiaries, said the average adjusted payments per procedure for all four types of testing dropped in 2013, after rising in 2012. New competitive pressures from the early introduction of health insurance exchanges, as well as an “expanding share of consumer-directed and high-deductible health plans in the market” may have contributed to the drop in prices, the authors said.
“When patients pay a greater portion of medical care costs out of their own pockets, they are more likely to shop for more affordable options, or even change their mind about undergoing the imaging procedure, which would explain the drop in utilization of the more expensive imaging modalities, such as CT, MRI, and PET,” they said.
The study was co-authored by Michal Horný, a PhD candidate in health services research at SPH; James Burgess, professor of health policy and management at SPH; and Alan Cohen, professor of health policy and management at the BU Questrom School of Business.