Every $1 spent on inpatient imaging translates into $3 in overall savings.

With the cost of health care making daily headlines, it’s important to remember that ensuring patient access to the right scan at the right time produces cost savings and healthier, more productive workers. Many times, these savings are easily recognizable, such as when medical imaging technology prevents unnecessary surgery. Other times, these savings are not as obvious, as when imaging allows a patient to return to work sooner due to a quicker recovery.

Research Proves Value

Peer-reviewed data demonstrates how imaging is cost-effective in the clinical setting. For example, a recent study using National Oncologic PET Registry data and published in the Journal of Clinical Oncology concluded that the knowledge physicians gained from PET scans changed treatment courses in 36% of cancer patients. This type of data demonstrates the value that PET scans have not only in helping cancer patients beat their disease, but also in reducing health care expenditures by better informing treatment decisions to be as effective as possible.

As a result of this powerful PET data, the Centers for Medicare and Medicaid Services (CMS) recently proposed a national coverage determination that would ensure Medicare coverage for PET scans to help guide patients’ initial treatment strategy. We applaud the proposed decision and hope it will remain positive when CMS issues its final national coverage determination in April 2009, as the research shows that improved access to PET technology will lead to better health outcomes for seniors and produce cost savings.

Another recent example of the importance of medical imaging is the 2008 national ACRIN trial, which was published in the New England Journal of Medicine and demonstrated that virtual colonoscopy was “highly effective” in detecting relevant polyps, and comparable in effectiveness to standard colonoscopy. The ACRIN researchers also declared that “the low risk of procedure-related complications, as compared with [standard] colonoscopy, may be attractive to patients and may improve screening-adherence rates.”

PET technology is not alone in demonstrating decisive cost savings benefits. A 2007 clinical study published in the Journal of Cardiovascular Computed Tomography found that using coronary computed tomography angiography (CCTA) as a gate-keeper screening prior to catheterization reduces costs by $1,454, a savings of nearly 50% over the straight-to-catheterization approach.

Indeed, on the whole, a study conducted by researchers at Harvard Medical School demonstrated that every $1 spent on inpatient imaging translates into approximately $3 in overall savings.

Cuts Threaten Patient Care

Yet while academic researchers and clinical experts are declaring tremendous value in imaging technologies, policymakers and payors often overlook the long-term benefits and seek to control health care costs by restricting coverage of medical imaging services. In fact, imaging services have been subjected to disproportionate cuts in recent years. These short-sighted measures are detrimental to patient care and health care value.

For example, we should be deeply concerned about the consequences of the Deficit Reduction Act (DRA) of 2005, which made massive cuts to reimbursements for medical imaging. More than $1.5 billion was cut in 2007 alone—the first year the DRA cuts were implemented. This was three times the level anticipated by Congress. These types of arbitrary cuts will negatively affect patient access to noninvasive diagnostic and therapeutic treatments.

The Government Accountability Office (GAO) has found that growth of advanced imaging services has already slowed significantly as a result of the DRA. An analysis of 2007 Medicare data confirms the GAO’s findings (which examined Medicare claims data only through 2006) that spending on imaging services has dramatically decreased while the growth of imaging use has flattened. Further reductions to Medicare reimbursement would impact patient access to life-saving services and affect rural Americans first.

A Better Way Forward

The current policy environment makes it essential that we communicate to legislators not only the clinical and economic value of medical imaging —as with the case of PET technology’s impact on cancer treatment—but also the proactive public policies that can leverage that value without compromising patient care.

A perfect example of positive policy solutions is the provisions for both appropriateness criteria and accreditation that were included in last year’s Medicare Improvements for Patients and Providers Act of 2008 (MIPPA). These policies, especially when coupled with the promise of health information technology, offer an optimal solution for patients, providers, and payors alike by ensuring the right scan is ordered for the right patient at the right time.

Accreditation

Accreditation is an efficient process of both self-assessment and independent external expert audit by professional medical entities, based on established guidelines and technical standards. Accreditation programs evaluate the qualifications of a provider’s personnel and safety policies specific to each imaging modality, the quality of clinical images and quality control processes, as well as the use of best practices and guidelines-driven protocols in delivering care.

Appropriateness Criteria

Throughout the past decade, as imaging has continued to be increasingly integral to best practices in health care diagnosis and treatment, appropriateness guidelines related to imaging have significantly increased. In fact, leading private health systems, such as Massachusetts General Hospital and United Health Care, are currently using or piloting appropriateness criteria to guide utilization, and a 2009 study published in the Journal of Radiology confirms that appropriateness criteria and associated tools reduce imaging use and cost while preserving access. Appropriateness criteria will ensure that imaging providers are using evidence-based guidelines to drive patient care decisions.

It is clear that medical imaging has a critical role to play in health care reform. And it is essential to promote policies such as appropriateness criteria and accreditation that have already been developed and proven effective to ensure proper utilization of medical imaging technology without undercutting patient access and quality of care. Most importantly, we must continue to express the value of medical imaging in terms of saving lives and dollars.

Ilyse Schuman is the managing director of the Medical Imaging & Technology Alliance (MITA). MITA, a division of the National Electrical Manufacturers Association (NEMA), is the collective voice of medical imaging equipment manufacturers, innovators, and product developers. Schuman is the former Minority staff director and chief counsel, Senate Committee on Health, Education, Labor and Pensions, and chief labor counsel, Senate Subcommittee on Employment, Safety and Training. She resides in Washington, DC.