From the November 2016 issue of HealthCare Business News magazine


Jung also sees this pattern, in reporting that “we still do some lower and upper GI work and IVPs, but a lot of that has migrated over to CT.” Of course, there are some things that straight X-rays will never do well. So, for evident reasons, as Launders puts it, the things that have already shifted away from X-ray are anything involving soft tissues. And, as Silva observes, “things like stroke care and any study of the brain will involve MRs that provided more appropriate, actionable information for diagnoses.”

But the rush to use ‘higher’ modalities first may be moderating
As Launders explained, plain film X-ray has previously lost some ground to the “competition,” partly because of the reimbursement structure in the U.S. and partly because people wanted to use the CT scanner as much as possible when it was new. “That may not be what was happening, but that’s the perception, anyway,” he said. As a result, CT use dramatically exploded.
“But now there are questions about [the] need for that and things are shifting somewhat back to radiography,” he said. As Jung sees the issue, the key is that there is now focus on radiation dosage and overutilization in CT scans, which may bring some of that work back. “With the radiation dose of CT high on the radar, especially in pediatrics, choosing ultrasound for an app scan study is becoming the first choice, rather than doing a CT on the child," he said. Another segment that Jung believes ultrasound may take away from CT is in cases of younger females with pelvic pain. Ultrasound should be the choice before CT, because of the reduced risk to the organs of a young female.

Launders summarized the issue: “In the past, physicians called for things to be done on the high-end stuff. This may have led to some inappropriate CT and MR use. Now things are being corrected because people are being more careful and spending more time looking at the referrals. Historically, the radiology department just scanned everyone they were given. Radiologists have really looked into it and stopped some inappropriate studies. That’s changing things. People were skipping the triage steps and going straight to more advanced studies like MR. Now X-ray can be seen as a triage step before going to [the] use of more expensive technologies. That could drive more studies to X-ray technology.”

The impact of costs and reimbursement rates
Then there is the issue of cost-benefit. It has been a “temptation for doctors to go straight to MR because they will get their answers quicker,” Launders said. “But the MR is a far more expensive study to do. To fit-out an MR room, you are looking at $2 million to cover a maximum of 20 patients per day, while a radiographic room can be fit-out for $300,000 and you can probably do 40-60 patients a day in it. The costs are very different. Even if you look at interventional radiology with state-of-the-art systems. They are very expensive and we are seeing that they are being used more for interventions and not for diagnostics.” These cost issues are becoming particularly relevant in the new health care financial climate.

November 2016 Magazine

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