Non-Invasive Imaging Use Continues to Decline

The use of noninvasive diagnostic imaging has declined over the past decade and a half, with only CT imaging showing slight growth, according to an article published in the journal Health Affairs.

Researchers from Thomas Jefferson University Hospital in Philadelphia examined recent data to determine if previously reported levelling off of the use of imaging has continued. They gathered more recent data from the nationwide Medicare Part B databases for the period 2001 to 2014 and calculated utilization rates per 1,000 enrollees for all advanced imaging modalities.

The researchers plotted trends in the utilization rates of the advanced imaging modalities (CT, MRI, nuclear imaging, echocardiography, and non-cardiac ultrasound), the utilization rate of conventional X-ray-based imaging (plain radiography, fluoroscopic examinations, and mammography), the overall fee-for-service Medicare utilization rate of all noninvasive diagnostic imaging, the relative value units (RVU) rates of the advanced imaging modalities and X-ray-based imaging, and the overall RVU rate of all noninvasive diagnostic imaging.

The results showed while all advanced noninvasive diagnostic imaging modalities showed rapid growth in use in the early years of the decade 2001 to 2010, echocardiography was the modality most frequently used. Since its peak in 2008, the number has steadily dropped:

2001

2008

2009

2014

Echocardiography

Per 1,000 beneficiaries

462

656

257

237

Nuclear imaging also has dropped significantly since its earlier peak:

2001

2006

2009

2010

2014

Nuclear imaging

Per 1,000 beneficiaries

218

307

285

117

87

CT utilization rate grew rapidly initially, and dropped, staying stable for a few years, but is now growing again:

2001

2009

2010

2011

2012

2013

2014

Computed tomography

Per 1,000 beneficiaries

361

637

626

500

498

500

514

There were a number of factors affecting the growth and decline of imaging tests, the researchers said. Initially, more tests were ordered because of their use in diagnosis, easy availability of the examinations, patients requesting the examinations, and a desire to ensure they’ve ruled out all possibilities. However, as costs increased, procedures were bundled, and the Deficit Reduction Act of 2005, imaging use began to decline.

The researchers concluded  the earlier rapid growth in the use of noninvasive diagnostic imaging stopped around 2008 and slowly began declining with the exception of CT imaging.

“A variety of factors are at work that will influence imaging trends in coming years,” they wrote. “Some will tend to promote greater use, while others will tend to restrict it. In view of the complex interplay of these factors, predicting future use is difficult. However, we believe it most likely that, absent further major code bundling, imaging use rates and RVU rates will remain at current levels for the foreseeable future without sustained or significant moves in either direction.”