Medical imaging makes diagnosis of abnormalities quicker and less invasive. It allows doctors to detect disease earlier, improve patient outcomes, and ultimately save on medical costs. In fact, the New England Journal of Medicine counts medical imaging as one of the top medical developments of the past thousand years. Since the year 2000, utilization of medical imaging has experienced ebbs and flows, dependent on factors including overall economic conditions, Medicare rules, and private insurer coverage. Here are some of the utilization trends in medical imaging in the private sector in recent years.
The Early 2000s: Growth in Medical Imaging Utilization
From 2000 to 2004, use of MRI, CT, and PET imaging increased rapidly, with PET utilization increasing by almost 400%. Primary drivers of this increase in utilization were physician self-referrals and independent diagnostic test facilities. During this time, growth in the use of advanced medical imaging technologies like MRI and PET in hospitals was smaller.
2009-2011: Reduction in Use of Medical Imaging
Growth in utilization of medical imaging continued through 2009, though at slower rates than the previous years. However, rates of diagnostic imaging dropped from 2009 to 2010, with CT and MRI imaging rates dropping most. Payments for medical imaging also decreased at that time. Reasons for this drop are attributed to enactment of the Deficit Reduction Act in 2007, as well as the US financial crisis of 2008.
Drivers of Medical Imaging Growth
In 2011, medical imaging utilization rebounded, with the exception of a slight decrease in rates of PET imaging. Clinical, economic, and legal factors are considered to be primary drivers of the rebound in medical imaging since 2011.
Clinical factors include the many studies linking medical imaging to longer life expectancy, lower need for exploratory surgery, lower hospital admission rates, and shorter hospital stays. In emergency settings, medical imaging shortens patient wait times and facilitates triage in both trauma and non-trauma presentations.
Medical liability considerations affect physician decisions about use of medical imaging. There are currently no “safe harbor” tort protections for physicians who follow accepted guidelines like those of clinical decision support (CDS) systems, and this may affect utilization rates for medical imaging.
Economic factors driving growth in demand for medical imaging vary, from equipment availability to a rebounding economy, to an increase in the number of privately insured Americans under the ACA.
Constraints on Growth in Medical Imaging Utilization
An increase in the number of radiology benefits manager (RBM) programs by private payers (as well as Medicare Advantage programs) has placed some controls on utilization of medical imaging through pre-authorization processes. However, pre-authorization tools are being increasingly challenged, based on the “hassle factor” for patients and doctors, as well as the possibilities of delays in care, vague pre-certification guidelines, and the possibility of clinical decision-making by people who may not have medical training. Additionally, some of the savings private insurers have enjoyed because of RBMs has been shown to come at the expense of referring physicians due to cost shifting from insurers to providers.
Many physicians and medical imaging technology groups have advocated instead for use of real-time CDS tools, which have demonstrated savings with fewer delays in patient care and less intrusion into the doctor-patient relationship.
Outlook for Medical Imaging Growth
The global market for medical imaging devices is expected to be $32.3 billion this year, and the global market is expected to exceed $49 billion by 2020, maintaining an annual growth rate of 7%. Factors driving the projected increase in utilization of medical imaging include demographic changes (an aging population), an increase in the number of privately insured Americans, and technological advancements expected to bring patient- and physician-friendly solutions that will enhance safety and ease of use of equipment.
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