Utilization management firm pitches patients on dose concerns

A website that allows patients to calculate radiation exposure levels for particular exams is drawing fire from some radiologists, who question whether the health plan-owned company is using safety as a smokescreen for profit management.

With a few clicks, visitors to Patient Safety choose a procedure - Bone Density, CT, PET exam, CTA, or nuclear medicine tests - and see specific body parts of an animated woman become illuminated.

The program compares the radiation exposure to that from a chest x-ray to the estimated annual radiation from sunlight. Along with an explanation of common uses for individual exams, the program offers alternative diagnostic tests. The alternative costs less in some instances.

"This is not a service to anyone," Richard L. Morin, Ph.D., chair of the American College of Radiology Safety Committee, told American Medical News. "The population that looks at this, whether it be physicians or patients, should realize these are estimates and no one can give them an absolute answer."

Although Chicago-based American Imaging Management's main business is clinical review of imaging orders, a spokesperson said the company is equally concerned with educating its 20 million members about the health risks of radiation.

"The arguments that there are ulterior motives or that we are really doing it to scare patients, frankly that's a little bit insulting to us,'' said Paul Danao, AIM's vice president of business development. "We're not trying to own the issue of patient safety but believe we have a valid reason to be involved in the discussion.''

Responding to revelations concerning the U.S. public's growing exposure to radiation from medical imaging, an ACR blue ribbon panel recommended sweeping changes for policies governing the tracking and physician management of radiation exposure.

The 2007 proposal supported a standardized method for achieving individual patient radiation data documenting exposure during medical imaging. The information would be used to benchmark good medical practices and to identify patients who have accumulated high levels of radiation from frequent imaging sessions involving ionizing radiation.

AIM, a subsidiary of WellPoint, already notifies physicians of duplicate exams and will start flagging patients who have high levels of radiation exposure later this year.

"The only thing we will be doing is informing the physician,'' Danao said.

Meanwhile the Patient Safety website offers an easy-to-use tool to measure potential risks of exposure, he said.

For Bone Density CT, a site visitor would see a woman's "skeleton" illuminated along with information on common uses for the modality, alternative exams, and exposure levels, which in this case happens to be relatively low, 0.01 mSv. Still, the Patient Safety site indicates that DEXA is the cheaper, safer modality.

Radiation exposure from coronary CT, by comparison, produces radiation levels of 8 mSv, equivalent to 400 chest x-rays, or 2.19 years of natural sunlight. As an alternative, the site lists "Coronary artery MRA, where available and technically feasible."

Since its Feb. 21 launch, Patient Safety has generated 6200 hits from across the U.S. and 21 countries, he said.

The company acknowledged there are nuances not communicated at Patient Safety. The site does not provide sourcing information or allow for individual patient statistics.

"We are certainly saying there are opportunities for us to improve," Danao said.

To our readers: Should utilization management firms be instructing patients on dose? Let us know your thoughts via e-mail: john.hayes@cmpmedica.com