Utilization Management Program Reduces High-Cost Imaging

Use of high-cost imaging among stable patients cared for by PCPs shows that a comprehensive utilization management (UM) program produces significant and sustained reduction in high-cost imaging volume, according to a study published in Radiology.

Researchers from Massachusetts General Hospital in Boston performed a retrospective seven-year cohort study to quantify the effect of a comprehensive, long-term, provider-led UM program on high-cost imaging, including CT, MR imaging, nuclear imaging, and PET, all performed on an outpatient basis.

The study included all patients regularly seen by PCPs at an urban academic medical center and the main outcome was the number of outpatient high-cost imaging examinations per patient per year ordered by the patient’s PCP or by any specialist.

The results showed that the patient cohort increased in size from 88,959 in 2007 to 109,823 in 2013. The overall high-cost imaging utilization went from 0.43 examinations per year in 2007 to 0.34 examinations per year in 2013, a decrease of 21.33%. Similarly adjusted routine laboratory study utilization decreased by less than half that rate. On the basis of unadjusted data, outpatient high-cost imaging utilization in this cohort decreased 28%, compared with a 20% decrease in statewide utilization.

The researchers concluded that their analysis of high-cost imaging utilization in a stable cohort of patients cared for by PCPs during a 7-year period showed that comprehensive UM can produce a significant and sustained reduction in risk-adjusted per-patient year outpatient high-cost imaging volume.