Imaging Tests Pushing Up Costs for Health Insurers
As diagnostic imaging, such as PET scans or MRIs, continues to grow in popularity, insurers are looking to limit coverage of the costly scans, the Baltimore Sun reports. Diagnostic imaging accounts for about $100 billion annually, or about 5% of national health care spending.
Medicare payments to physicians for imaging had "by far the highest growth rate" of medical billing categories examined in a 2000 to 2005 study by the CMS Office of the Actuary. A 2004 study published in the journal Stroke found that the cost of medical scans is offset by allowing physicians to make earlier diagnoses and getting a patient to start treatment more quickly.
In addition, improved imaging technology "has vastly reduced the need for expensive exploratory or unneeded surgery," according to the Sun. However, there also are instances "where unneeded scans are ordered, or where a less costly alternative would have sufficed," the Sun reports.
There also is concern that many doctors are overusing self-referrals to boost revenue. Some insurers are paying lower rates for imaging services in an attempt to "rein in costs," the Sun reports. Medicare this year instituted limits on certain fees paid to doctors, which are expected to reduce the amount spent on imaging, according to the Sun.
Most radiology benefit managers are trying to control costs through requiring prior authorization of scans. According to a November 2006 study published in the Journal of the American College of Radiology, a requirement that doctors receive prior authorization for scans was found to decrease CT scans by a third and MRIs by 9% during the two years that the requirement was instituted.
However, receiving authorization can be a "tedious" and time-consuming process, the Sun reports (Salganik, Baltimore Sun, 5/13).