Blanket Reimbursement Reductions for Imaging May Backfire

The application of blanket reductions, meant to cut over-used imaging, may have negative consequences for patients who actual do need the testing, say researchers in an article from the April issue of Health Affairs.

In order to assess the effectiveness reducing imaging, researchers performed a cross-sectional study of prostate cancer patients from 2004 to 2005. The patients were 66 to 85 years old and came from 16 regions. The researchers identified risk using the 2003 guidelines of the National Comprehensive Cancer Network. Of the total, 18,491 men were considered low risk, 10,562 were high risk.

Patients who were high risk – those with clinical stage of at least T3, a Gleason score greater than seven, prostate-specific antigen great than 10 ng/mL, or symptoms of advanced disease – were deemed to be appropriately scanned.

Low-risk patients also received appropriate scanning (CT for planning) if they were undergoing external beam radiation therapy. All other patients who were low-risk and who had undergone an imaging scan were deemed to be inappropriately scanned.

The researchers found that appropriate scanning was performed most often in same areas where inappropriate scanning was performed most often. “We found that regions with lower rates of inappropriate imaging also had lower rates of appropriate imaging,” wrote the authors.

Coined the “thermostat model” of regional health care utilization, the researchers suggest that blanket cuts to imaging would decrease not only inappropriate imaging, but imaging that is appropriate, limiting access to patients who clearly qualify.