Medical imaging as a Medicare cost driver? Think again

It is past time to debunk the persistent myth that medical imaging is driving skyrocketing Medicare expenditures.   

Analysis of the most recent spending data is essential for policymakers seeking Medicare savings. Case in point: the overall impact of diagnostic imaging as a reimbursable health care service for Medicare beneficiaries.

Though diagnostic imaging had been one of the fastest growing categories of Medicare spending in the early 2000s, it is now one of the slowest, according to a new study published in the December issue of the American Journal of Roentgenology (AJR).

{mosads}Contrary to the widely-accepted notion that imaging is a leading factor in rising Medicare expenditures, imaging is now at the bottom of the list compared to other services.  Of the 44 spending categories studied, advanced medical imaging was surpassed by 37 other categories. Standard medical imaging, ultrasound and cardiac/other imaging ranked 33^rd, 34^th and 39^th, respectively, in terms of spending growth.

Spending growth on diagnostic imaging was in the 80th percentile of all Medicare services in 2001. By 2011, however, spending for diagnostic imaging drastically slowed to the point where it now resides only in the second growth percentile and is one of the fastest declining Medicare service categories.

So how does a service that was once a top cost driver for Medicare slow in growth while other reimbursable health care services continue to climb?

Prior to the multiple Medicare reimbursement cuts for advanced imaging that began in 2006, Medicare spending for these services had indeed been on the rise. There was very good reason for this growth: many new imaging technologies became available in the 2000s, leading to significant advances in diagnostic accuracy and improvements in patient care. However, Congress and the Centers for Medicare and Medicaid Services (CMS) ignored the clinical and economic value that these improvements made, and indiscriminately cut imaging reimbursement across the board.  The Deficit Reduction Act (DRA) of 2005, changes in practice expense and equipment usage payment methods, bundle payments for certain services and incremental discounting known as the Multiple Procedure Payment Reduction (MPPR) all served as very blunt instruments to halt the growth of imaging expenditures over a time span of approximately seven years. 

It doesn’t require a great leap of logic to determine that repeated deep reductions in Medicare reimbursement for medical imaging triggered a downward trend in expenditure growth. Indeed, recent evidence from an analysis of Medicare claims data shows that Medicare spending on medical imaging declined between 2006 and 2010. Up until now, it has been unclear how that spending decrease compares with changes in spending for other services within the Medicare program. As policymakers seek to control skyrocketing health care costs, understanding such shifts in Medicare spending is essential. 

While the AJR study on Medicare spending does not address the full spectrum of factors potentially contributing to the decline in the growth of imaging, we know that advances in medical imaging technology and clinical practice, access to electronic health records and increased use of clinical decision support tools have enabled physicians to work smarter. The implementation of these efficiency measures are potential causes of slowed growth outside of multiple Medicare funding reductions.

In spite of this, recent, drastic cuts to Medicare reimbursement for medical imaging have seriously threatened patient access to life-saving diagnostic tools. Additional cuts would only increase long-term health care costs by making it more difficult for physicians to detect cancer and other diseases at an early stage and more difficult to effectively manage patients’ treatment . As health care and Medicare costs continue to climb, decision makers in Washington should keep in mind these irrefutable facts and consider directing future cost-cutting initiatives to the now-leading service categories.

Rodriguez is the executive director of the Medical Imaging & Technology Alliance (MITA), the collective voice of medical imaging equipment, radiation therapy and radiopharmaceutical manufacturers, innovators and product developers.