Demand for RF exams goes up…no, down...no, wait

With concerns about x-ray exposure mushrooming and anecdotes circulating about patients balking at exams involving ionizing radiation despite a commanding medical need for those exams, it's not surprising to hear of documentation that the number of procedures for any x-ray related modality has gone down. Such was the case earlier this week, when the IMV Medical Information Division released the results of a survey that studies performed using radiography/fluoroscopy equipment at hospitals with more than 150 beds dropped about 9% from 2004 to 2009.

The survey found that 19.3 million procedures were performed in RF rooms in 2004 compared with 2009’s total of 17.2 million procedures for 150+ bed hospitals. This translates into an average annual decrease of 2% per year. But wait a minute. Like many things involving statistics, the significance of the numbers may be elusive.

The drop in procedure volume is spread over a five-year period. This means the trend downward may be accelerating in recent years. Or, for that matter, it might be leveling off and rising again after a steep fall early on.

In the context of burgeoning concerns among the American patient population about x-radiation, one might conclude that the most likely scenario involves the extension of an earlier growth trend, seen in the beginning of the decade, marked by a fall-off in demand over the last couple of years due to radiation concerns. Drawing such a conclusion, however, may not be warranted.

Buried in the IMV numbers is a seemingly contradictory rise in the number of patient visits to RF departments, 3.5% per year in the five years from 2004 to 2009. Meanwhile, IMV reports that the total RF installed base declined over the past decade. Its 2009/10 census identifies 4805 RF units at 2070 hospitals with 150+ beds, which is 24% less than the total of 6360 installed units noted in IMV’s 1998/99 census. This translates into an average annual RF installed base decrease of 2% to 3% per year from 1909 to 2009.

So here we have a paradox: fewer procedures, but more patient visits to fewer sites. But wait, there’s more. One of the details noted in the IMV research summary is that the mix of procedures has changed. Notably the numbers of GI contrast and ERCP studies have declined.

So now pundits are left scratching their heads. Demand usually drives the purchase of imaging equipment. So, if procedure volumes are down, does that mean demand for equipment is falling? Not necessarily. Here’s the next twist.

IMV notes that 26% of the census sites reported plans to acquire RF units from 2009 to 2012. Good news, right? Well…yes and no. The percentage of sites planning to purchase “over the next three years” has decreased from 34% of the sites covered in IMV’s 2004/05 census and 39% of the sites covered in IMV’s 2003 census. Therefore, news that one out of four sites expects to buy new equipment in the next several years is not very reassuring, considering that the installed base of RF rooms declined in the years after two IMV surveys reported stronger interest in the purchase of this equipment than is now being indicated.

The lesson to be taken from these kinds of reports is one woven into just about every economic story being reported today. The economy in this country is in a state of flux, punctuated by contradictory trends. And there seems no end in sight.

If any conclusions can be drawn reliably, they must include historical data and the most fundamental forces. Let’s start with indisputable facts. The number of installed RF units in the U.S. has declined over the last decade despite a slightly increasing number of patient visits. The kinds and the numbers of exams have gone down, despite this rise in visits. This very likely means that demand is continuing, but arguably providers are getting smarter in the number and types of exams being done, finding ways to reduce dose without affecting the quality of the diagnostic information.

Some of this may even come down to the use of more sophisticated digital technology, exemplified by advanced flat-panel detectors, such as the wired and, most recently, wireless panels on the market. It may be especially noteworthy that of the RF units planned for acquisition, 54% are expected to have a flat-panel detector.

So as we look forward, demand for bread-and-butter kinds of procedures involving ionizing radiation, such as those in RF rooms, can be expected to continue. Equipment sales will continue as well. But the apple-to-apple kinds of comparisons that made projections easy in the past have gone away and will not return.

Qualitative interpretations of the provider marketplace will have to suffice, as we all take a collective deep breath…and hold it.