Finding Ways to Demonstrate Value

New committee promotes and coordinates efforts to measure the importance of imaging.Demonstrating Value

To allow the College to play an integral role in coordinating imaging health-policy research, I am pleased to announce that John A. Patti, M.D., FACR, chair of the ACR Board of Chancellors has recently approved the request of the Commission on Economics to create the ACR Committee for Imaging Health Policy and Economics Research (CIPER).

Richard Duszak Jr., M.D., FACR, will chair the new committee. As a previous CPT® advisor, current CPT Editorial Panel member, and former vice-chair of the Commission, Duszak has long been involved in College economics activities. His extensive experience in imaging health-policy research combined with his understanding of the issues facing our specialty makes him especially suited for his role as CIPER chair. In addition, two new ACR staff members will work with the committee: Martey Dodoo, Ph.D., a senior health economist with considerable experience in the health-care industry, and Nadia Husain, a biostatistician.

In recent years, radiology has experienced a series of targeted payment reductions premised largely on the fact that the growth in the volume and spending on imaging has exceeded that of other medical services. Policy-makers, such as MedPAC, have suggested that mispricing imaging services and the fee-for-service payment system have created the incentives that led to the rapid growth in imaging. Besides the fact that there is little data to support such conclusions, we know that these are flawed assumptions because, except in the self-referral setting, radiologists do not order the examinations. However, at a time when our government payment system is starved for resources, convincing policy-makers that their beliefs are incorrect has been a significant challenge for us. All too often, imaging is seen by many as a cost to the system rather than an indispensable problem-solving tool. In future payment models, policy-makers' current perceptions could lead to commoditization of imaging services rather than the development of an integral service line.

The alternative premise is that the volume of imaging services has grown because imaging is valuable to the health-care enterprise and, imaging will continue to play a vital role in triage and in the management of significant illnesses in any future health-care delivery models. While intuitive to radiologists, this statement has been difficult to prove.

In 2001, at the beginning of the boom in imaging growth, Health Affairs published results of a survey of leading internists designed to determine the relative importance of many new medications, diagnostic techniques, and surgical procedures developed over the past 30 years1, all of which have helped patients live longer, better quality lives. The authors noted that while the efficacy and safety of these new innovations had been studied through randomized clinical trials, there was a dearth of systematic information about different innovations' relative importance to patients.

The survey demonstrated that crossectional imaging using CT and MRI was the most important medical innovation of the past 30 years, outpacing angiotensin-converting-enzyme inhibitors, balloon angioplasty, statins, and mammography. Based on this impression of the value of imaging to the medical community and imaging's ability to replace more invasive therapies and diagnostic tests with image-guided, minimally invasive techniques, it's no wonder that use of cross-sectional imaging and therapeutic procedures in the management of complex patients has increased.

Simply put, the growth in the use of imaging in health care has occurred because it adds value to patient care. However, we can meet with policy-makers and state our case, but without the evidence to support our position, we may be seen as self-serving advocates and lobbyists for our profession. That is an important perspective considering that members of Congress and decision makers at CMS can be swayed more with data than by lobbying alone.

Within the College, members of our Future Trends Committee have also noted the need for literature demonstrating the value of imaging and have developed a robust list of topics for the CIPER to consider and prioritize. Members of the commission in the trenches with the CPT code development process and the valuation and payer coverage of imaging services frequently request more data to support what we believe to be correct regarding the increasing complexity of imaging examinations and the causes for growth in volume of particular services.

While some literature supports the value of imaging in health care, the need for more data remains acute. In the era of "evidence-based medicine," quality research is necessary to prove the value of any medical service, and without such data, many will presume there is little value in imaging for patients.

The ACR already supports clinical comparative-effectiveness research through our Commission on Research and Technology and Commission on Quality and Safety. In contrast, CIPER will focus on how imaging adds value and other related topics in health-care policy and economics. The committee has been charged with not only doing some of the smaller data-mining projects but also with helping to coordinate industry and other societies' efforts to assure we are using all of our collective resources wisely.

How radiology will ultimately fit into any new delivery system remains unclear, but understanding our environment and demonstrating the value of appropriate imaging to policy-makers, while challenging, will be key to the success of our specialty and our mission to provide the best possible care to our patients and our communities. CIPER stands ready to help meet that challenge.

1. Fuchs V, Sox H. “Physicians View of the Importance of Thirty Medical Innovations,” Health Affairs, September 2001;20(5):30-42.

bibb allen jrBy Bibb Allen Jr., M.D., FACR

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