Are Hospital Stay Increases Related to Imaging Declines?

Medical imaging use and costs have declined in recent years. But has this downward trend affected quality and patient safety?

It’s a question posed by Richard Duszak, MD, FACR, of the Harvey L. Neiman Health Policy Institute. In the think tank’s first report, Duszak, the institute's CEO and senior research fellow, questions the implications of declining imaging utilization.

“It would not be illogical to say that some of those salutary affects [of medical imaging’s utility] could be minimized if imaging decreases,” Duszak told reporters on a teleconference discussing the report “Medical Imaging: Is the Growth Boom Over?”

Imaging use and spending has declined dramatically in recent years. At the same time, hospital stay has gone up. Although this finding wasn’t part of the institute’s analysis, this coincidence is relevant, Duszak said.

“Have we identified the tip of an iceberg?” he said. “Such associations need to be considered.”

Since 2006, imaging use is down nearly 5 percent and spending on imaging is down 21 percent. The decline is attributed to $6 billion in Medicare funding cuts, greater use of appropriateness criteria, efforts to raise dose awareness, and increased use of electronic health records, Duszak said. Hospital stay, meanwhile, increased from 4.9 days to 5.2 days, which is about a 6 percent increase. The added cost to the system from this trend could be $17 billion to $21 billion per year, the report states.

Recent peer-reviewed studies have identified a correlation between imaging and hospital admissions and stay, the report notes. One study showed that for patients arriving to the ER with chest pain, coronary CT angiography allowed fewer admissions and shorter says. Another study showed that people who had imaging early in their admission process had shorter stays than those who had imaging later.

Duszak said more research is necessary to determine the relationship between declining imaging use and increased hospital stay or overall decline in quality and patient safety. Regardless, policy makers must focus on the overall downstream cost of imaging reduction - safety, access, and sustainability, for example - rather than focus solely on cost.

“We need to pay very careful attention to the implications of this decreased utilization, and policy makers need to keep this in mind,” he said. “Possibly we have had some of that happen and we have not recognized it yet.”

The Access to Medical Imaging Coalition (AMIC) lauded the report, echoing Duszak’s point that lawmakers should refer to the latest data on utilization and spending trends when considering imaging cuts.

“Patient access to advanced imaging technologies saves lives and can reduce long-term costs for the healthcare system by spurring detection, diagnosis and treatment of disease,” AMIC executive director Tim Trysla said in a statement.