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ABSTRACT The growth in the use of advanced imaging for Medicare beneficiaries decelerated in 2006 and 2007, ending a decade of growth that had exceeded 6 percent annually. The slowdown raises three questions. Did the slowdown in growth of imaging under Medicare persist and extend to the non-Medicare insured? What factors caused the slowdown? Was the slowdown good or bad for patients? Using claims file data and interviews with health care professionals, we found that the growth of imaging use among both Medicare beneficiaries and the non- Medicare insured slowed to 1-3 percent per year through 2009. One by-product of this deceleration in imaging growth was a weaker market for radiologists, who until recently could demand top salaries. The expansion of prior authorization, increased cost sharing, and other policies appear to have contributed to the slowdown. A meaningful fraction of the reduction in use involved imaging studies previously identified as having unproven medical value. What has occurred in the imaging field suggests incentive-based cost control measures can be a useful complement to comparative effectiveness research when a procedure's ultimate clinical benefit is uncertain.
Advanced diagnostic imaging-magnetic resonance imaging (MRI); computed tomography (CT); and nuclear medicine, including positron emission tomography (PET)-has produced substantially better health care and considerable health care costs.Fromthe mid-1990s through the mid-2000s, use of advanced imaging among Medicare beneficiaries grew by more than 6 percent per year.1
Multiple factors contributed to this expansion. Technological development permitted new applications, including accurate heart imaging and measurement of tumor activity. High reimbursements made imaging studies profitable for hospitals and imaging centers, and the introduction of small scanners made imaging profitable for physicians' offices.2,3 Imaging was rarely seen as harming patients, so there were few situations where imaging was ruled out. Demanding patients and defensive medicine also added to the growth.
Therefore, it was surprising that in the January 2010 issue of Health Affairs, David Levin and colleagues documented that the growth in Medicare utilization of advanced imaging had begun to slow in 2006 and 2007.4With health care costs under intense scrutiny, this finding raised three questions. First, did the slowdown of Medicare imaging utilization persist and extend to the nonelderly population? Second, was the slowdown a natural exhaustion of a trend, or did policies contribute?...