Is imaging’s procedure volume glass half empty or half full?

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Guest Post: Brian Casey, Editor in Chief,

A new report was published this week that probably isn’t a big surprise to anyone: The volume of medical imaging services paid for within the Medicare system dropped in 2009, the first such drop in 11 years.

The author, Brian Casey,

The report, sponsored by the Access to Medical Imaging Coalition (AMIC), found that the volume of advanced imaging services billed within the Medicare system decreased by 0.1% in 2009 compared with 2008, while overall imaging services declined by 7.1% for the same year-to-year comparison. You can read the full story on by clicking here.

I say the report is no surprise because several other recent studies have documented similar drops in imaging volume in the U.S., in particular a study presented at the 2010 RSNA meeting by Dr. David Levin and colleagues from Thomas Jefferson University. The declines have been across the board, both with respect to advanced imaging services like CT, MRI, and PET, but also more basic procedures like radiography and screening mammography.

It’s also no secret what’s causing the declines — big cuts in Medicare reimbursement for imaging procedures, such as those implemented in the Deficit Reduction Act of 2005 (DRA), coupled with increased scrutiny of imaging on the part of third-party payors, who are using radiology benefits management firms and other tools to cut back on what they see is inappropriate utilization.

AMIC portrayed this week’s report as an example of how Medicare beneficiaries are being denied access to lifesaving imaging technology. And if that’s really happening, it’s unfortunate — all of us in radiology are witnesses on a daily basis to the incredible power of imaging — to find hidden disease, change patient management, or treat a patient less invasively and with faster recovery than ever before

But if you step back and look at the report from another perspective, you’ll see that the procedure volume glass may actually be half full rather than half empty. Rightly or wrongly, medical imaging has taken a public relations beating in recent years as one of the drivers behind runaway healthcare costs in the U.S.

With imaging procedure volume slowing, maybe policymakers and administrators can at last step back and look at ways to manage imaging utilization wisely rather than through brute-force instruments like the DRA. Other positive moves in this direction include the announcement — also this month — that the Center for Medicare and Medicaid Services (CMS) is moving ahead on a pilot project to examine the role of clinical decision support software in directing appropriate imaging utilization.

So, I’m choosing to look at this week’s report with a positive spin, as a sign that radiology is getting its house in order and that perhaps inappropriate imaging utilization by other medical specialties is on the wane.

What’s your take? Is the glass half empty or half full?

– Brian Casey, Editor in Chief,

Editor’s Note: The views expressed by guest bloggers are soley those of the author, and do not necessarily reflect those of Carestream Health, Inc.


  • reply

    I’d join you on hoping that the radiology department would soon get its house in order. But as hopeful as we are, we also can not deny the fact that this department has always had its glass half empty.


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