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Study Finds Rise in Rate of Diagnostic Imaging in Managed Care
Date:11/10/2008

indman, MD, an associate professor of radiology and biomedical imaging, epidemiology and biostatistics, and obstetrics, gynecology, and reproductive sciences at UCSF.

The goal with newer imaging tests is to use them in the most efficient and effective way possible and as a replacement for older, less accurate tests, emphasized Smith-Bindman. "But we found the newer tests, such as CT and MRI, are being added on top of the old tests, such as X-rays, rather than replacing them -- and this increases costs.

"Like first-time parents taking baby pictures, we may be overdoing it with newer diagnostic imaging tests. Using these tests wisely can detect treatable diseases and save lives. Excess imaging may be too much of a good thing. In addition to health care costs, we need to consider patients' exposure to potentially cancer-causing radiation. The benefit of testing needs to be balanced against the risk," she said.

Smith-Bindman's study confirms previous reports of a trend toward over-imaging, including one that found imaging has risen faster than any other medical service that Medicare patients receive.

The study findings also highlight concern about a correlation between the type of health care practice and rates of imaging, Smith-Bindman said. "Unlike managed care systems such as Group Health that receive a fixed amount to care for each patient, 'fee-for-service' practices get financial rewards for doing extra testing, including recouping investments in office-based scanning equipment. It is likely that rates of testing are higher in fee-for-service practice, and this habit of doing more imaging may be spreading into managed care."

The study did not address the appropriateness of imaging and whether the increase was associated with improvements in patient care, and this is an area that needs further study, the research team noted.

"Our results definitely highlight the need to c
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