ACR calls report on skyrocketing imaging distorted

The American College of Radiology has attacked a report prepared by a trade group

representing cardiologists and other nonradiologists who interpret medical imaging, claiming the results misrepresent the real reasons for rapidly rising utilization.

The target of the ACR's ire is an analysis by the Lewin Group of Medicare costs between 2001 and 2003. The report, sponsored by the Coalition for Patient-Centered Imaging, found that hospital services and outpatient services - not self-referrals by nonradiologists - explain skyrocketing Medicare costs. The CPCI is closely associated with the American College of Cardiology and includes as members other nonradiologists who perform medical imaging.

"This analysis does not adequately address policy makers' concerns that growing in-office CT, MRI, and PET scanners are setting the base for a Medicare cost explosion and ignores a decade of data regarding increased volume of medical imaging procedures in self-referral situations by nonradiologists," said Dr. James Borgstede, chair of the ACR's board of chancellors, in a press release issued last week.

Medicare data show that image utilization among nonradiologists is the fastest growing type of physician service expenditure in the U.S., according to the ACR release. In-office imaging utilization among nonradiologists is double that of radiologists. At current rates, most CT and MR scanning may soon end up being performed at sites with little or no quality oversight, the statement said.

The CPCI analysis claims that the shift of services from hospital to private practices most accurately explains cost increases. Medicare figures, however, attribute only 20% of the increase to such shifts. The remaining 80% of the overall in-office utilization growth remains unaccounted for, according to the ACR release.

CPCI representatives defended the report, saying it looks at the big picture rather than concentrating on Medicare physician fee schedules as a source of imaging growth.

"When looking at growth in the Medicare costs for imaging, you have to look at the entire site of service in addition to the physician fee schedules," said Jill Rathbun, spokesperson for the American Society of Breast Surgeons, a CPCI member.

Analysis from the Medicare Payment Advisory Commission (MedPAC), on which the ACR based its opinion, examined only the physician fee schedule data to explain growth in imaging, Rathbun said.

The ACR rebuts the CPCI report's claims that rising imaging costs are offset by the number of invasive procedures that imaging can obviate. MedPAC research data show no significant correlation between imaging oversupply and health outcomes. All costs seem to be on the rise, and the extent of such offset is not clear at this point, the ACR release said.

According to the Lewin Group's study, on the other hand, ultrasound-guided biopsies saved Medicare $88 million in 2003 by replacing more invasive and costly surgical biopsies.

CPCI members contend that no imaging services should be limited until enough scientific data have accumulated to accurately reflect cost trends, Rathbun said.

For more information from the Diagnostic Imaging archives:

Radiologists and cardiologists square off before Congress

Federal imaging proposals mesh with ACR initiatives

Utilization review takes aim at imaging expenses

Medicare commission sets priorities for cutting imaging costs