AHIP White Paper Supports New GAO Findings on Inappropriate Use, Rapid Spending Growth for High Tech Imaging

WASHINGTON (Map) -

AHIP report focuses on concerns about quality and patient safety; Highlights effective private-sector health plan strategies

AHIP white paper on quality in high tech imaging: http://www.ahip.org/content/default.aspx?docid=24057

Link to GAO report on imaging services in Medicare Part B: http://www.gao.gov/new.items/d08452.pdf

WASHINGTON, July 28 /PRNewswire-USNewswire/ -- A new Government Accountability Office (GAO) report documents a dramatic surge in the use of high tech imaging under Medicare Part B, with rapid growth in spending, and draws attention to a substantial variation in the use of services across regions that suggests not all utilization is necessary or appropriate. Today, America's Health Insurance Plans (AHIP) released "Ensuring Quality through Appropriate Use of Diagnostic Imaging," a white paper that supports these findings and highlights health plan strategies that are working to address the quality, patient safety, and cost issues that our nation faces in the use of high tech imaging.

"Within our health care system, health plans often serve to identify and address emerging issues of patient safety and cost, and they set out to devise solutions to these problems," said AHIP President Karen Ignagni. "The GAO report is a good illustration that the private sector is serving as an early warning system on critical quality, safety, and cost issues in the U.S. health care system," she said.

GAO reports that Medicare spending for imaging services under Part B doubled from 2000 to 2006, increasing to about $14 billion annually, and that spending for high-tech imaging rose much faster. During the same period, GAO found, the proportion of imaging services performed in physician offices rose, while in-office spending per beneficiary varied substantially across regions, suggesting that not all utilization, according to GAO, was necessary or appropriate. The differences are striking, ranging from $62 per beneficiary in Vermont to $472 per beneficiary in Florida - an eight fold variation.

These are all alarming patterns that have also been observed in the private sector, according to the AHIP white paper, which reports that system wide spending on high tech imaging is approaching $100 billion a year, and that it is expected to double over the next four years.

AHIP's white paper references studies showing that a range of 20% - 50% of high-tech diagnostic imaging for a variety of conditions fail to provide information that improves patient diagnosis and treatment and may be considered redundant or unnecessary. McKinsey Global Institute says that $26.5 billion each year is spent on unnecessary use of CT scans and MRI tests alone.

According to the AHIP white paper, a major concern is the relationship between inappropriate imaging and unnecessary exposure to radiation. One estimate indicates that as many as 1.5% to 2% of all cancers in the U.S. may be attributable to radiation from CT scans, a concern that is magnified for children and pregnant women. Children, who are at risk because they are more sensitive to radiation and have more years in which to develop radiation-induced cancers, now account for four million scans each year. Pregnant women are exposed to twice as much radiation as they were ten years ago.

Health plans across the country have observed the trends documented in the GAO report and implemented radiology benefit management programs to address patient safety, quality and waste. Typically, programs are built in conjunction with network physicians and hospitals.

Radiology benefit management programs rarely result in denial but rather provide a process through which requests for imaging services can be evaluated for their appropriateness based on available medical evidence. These programs include key core components: use of evidence based guidelines, consultation between physicians in other specialties and radiology professionals, and feedback on individual practice patterns for practitioners.

Our members report that these programs are successful in orienting the use of high tech imaging to more appropriate interventions that fulfill the promise of longer and higher quality of life. Health plans have demonstrated an up to 82% decrease in utilization of inappropriate imaging, which has implications for quality, and reductions in spending of up to $2.00 per member per month over two years. Mature programs can hold annual cost trends between 5% and 7% and have reduced the average growth of utilization from 25% to 1%.

America's Health Insurance Plans - Providing Health Benefits to More Than 200 Million Americans