MassINC is a public interest research foundation that publishes Commonwealth magazine, an excellent public policy journal. The current issue has a fascinating article by Jack Sullivan about MRI imaging, entitled "Overexposed." Here's the link.
Here is a teaser, from the introductory passages:
Gov. Deval Patrick in April took the unprecedented step of rejecting double-digit rate increases being sought by most of the state’s health insurers for their small business plans. It was a popular move politically, but the governor was basically shooting the messenger because he didn’t like the message being delivered. He may have even shot himself in the foot because an appeals board within his administration later said the decision was wrong.
It was another reminder that rising health care costs are not subject to easy solutions. Health insurance rates keep rising because costs keep going up, and one of the biggest cost drivers in Massachusetts is medical imaging, the use of devices such as x-rays, MRIs, CT, and PET scans to take internal pictures of the body. These machines have revolutionized the practice of medicine, but their use in Massachusetts has grown faster than anywhere else on the planet.
Massachusetts, in fact, has become a medical imaging mecca. MRIs, or medical resonance imaging units, cost $1.5 million or more to purchase and an estimated $800,000 a year to operate. Massachusetts has 42 MRIs for every million residents, dwarfing the national average of 26, which is already higher than any other country. There are now more MRI units serving the 6.5 million residents of Massachusetts than there are for the 55 million residents of Australia and Canada combined.
At least $2 billion was spent on medical imaging in Massachusetts in 2008, up more than 20 percent from 2006. After medical procedures, imaging is the fastest growing health care expenditure in the state, exceeding the rate of increase for prescription drugs and administrative expenses.
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The described phenomenon is of course not limited to Massachusetts, but may be more visible there because of the possibly unparalleled multiplicity of academic medical centers in Boston. On top of the troubling self-referral issues, there is also evidence that specialty society recommendations for use of imaging are not being followed within ER's: a fairly recent study indicated that 44% of CT scans for trauma would not have been performed had American College of Radiology guidelines been followed. (AJR 2006: 186:937-42)
But, Paul, your much-maligned CMS is aware of this problem:
"..... the Centers for Medicare & Medicaid Services (CMS) has set aside $10 million for demonstration projects to develop computerized "decision support systems" or DSS programs that assist doctors to make the right choices from among 11 advanced imaging procedures. Thousands of physicians will be recruited, and compensated, to test various systems over a two-year period. The demonstration will rely on specified medical specialty society guidelines for these procedures." (Health Leaders Media, today)
Let us hope the project succeeds.
nonlocal MD
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