Q&A: Investigating State Level Trends in Imaging Costs

A recent study in AJR noted that spending on imaging has actually decreased in most of the U.S.

As various forms of radiology imaging became more accessible within the community, its use soared. According to data obtained from Medicare, imaging spending per beneficiary was $350.54 in 2004. This cost peaked at $405.41 by 2006, a 7.8% annual increase from baseline, and then began decreasing significantly to $298.63 in 2012, a 4.4% annual decrease from peak.

In a study recently published in the American Journal of Roentgenology, Andrew B. Rosenkrantz, MD, Danny R. Hughes, PhD, and Richard Duszak, MD, sought to determine state-level trends in Medicare spending on medical imaging. They found that while nearly all states saw spending decrease since the peak, two states bucked the trend and spent more. Maryland had a 12.5% average annual increase since 2005 and Oregon had a 4.8% average annual increase since 2008.

Diagnostic Imaging spoke with Andrew Rosenkrantz, MD, a radiologist at NYU Langone Medical Center in New York City, about the study and its implications.

Why was it important for you to do this study?

It has been well documented that national Medicare spending for medical imaging has decreased since about 2006. However, this trend has not been explored on a state-by-state basis. Geographic variation in utilization and spending is an important policy concern, and insights into such variation can help better understand the potential impact of relevant policy on access and outcomes.

Did you have any preconceived ideas of what you might find and if so, were there any surprises?[[{"type":"media","view_mode":"media_crop","fid":"42189","attributes":{"alt":"","class":"media-image media-image-right","id":"media_crop_277489849528","media_crop_h":"0","media_crop_image_style":"-1","media_crop_instance":"4542","media_crop_rotate":"0","media_crop_scale_h":"0","media_crop_scale_w":"0","media_crop_w":"0","media_crop_x":"0","media_crop_y":"0","style":"height: 170px; width: 170px; border-width: 0px; border-style: solid; margin: 1px; float: right;","title":"Andrew B. Rosenkrantz, MD","typeof":"foaf:Image"}}]]

It was surprising that only two states had actual spending increases during the time that all remaining states had spending decreases. In particular, Maryland and Oregon, both have federal waivers in place that support unique health plans in those states, perhaps shielding them from the impact of broader national trends. In addition, the abrupt nature in the decline in spending was notable in the sense that it began within the same two-year window in nearly every state.

What message would you like our readers to gain from this study?

The decrease in Medicare spending on medical imaging began abruptly in nearly every state in either 2005 or 2006, and was sustained during the following years. Nonetheless, there was substantial state-to-state variation in imaging spending, with such variation changing over time. Future relevant policy should consider the impact on access and outcomes that may result from such variation and substantial reductions in imaging spending.

Are there future topics for research that you suggest on this topic, and if so, what should they look at?

Future studies would be helpful to try and identify the exact causes of the observed imaging trends. In addition, studies could explore the variation at even smaller geographic units, such as cities and ZIP codes. Also, it would be useful to evaluate the impact of the observed changes in imaging spending, such as potential restricted access for patients in need of such exams.