Red, Yellow, Green: Appropriate Use of Diagnostic Imaging

Millions of Americans undergo costly and often invasive diagnostic procedures each year. Sometimes these tests help them avoid even more invasive tests, but are they really what the doctor ordered? Some new work in Minnesota points to signs that too many unnecessary high-tech diagnostic imaging (HTDI) scans are being made, which is a large contributing factor in the meteoric rise in health care costs.

HTDI use has been increasing at 15 percent to 20 percent annually—twice the rate of prescription drugs and far greater than the 10 percent annual increase in overall health care spending.

From 2000 to 2006, Medicare spending on HTDI skyrocketed from $3.6 billion to $7.5 billion, a more rapid ascent than that of any other physician-billed Medicare service during the same period.

In response, many health plans in Minnesota enacted prior notification (PN) rules requiring providers to contact a health plan service before ordering an MRI, CT, PET, or nuclear cardiology test to see if it would be covered by an insurance order.

Read the rest of this AF4Q Bright Spot here.

View the entire Illustrating Innovation Through Bright Spots book, produced for the May 2012 National Meeting here.