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Radiologist Criticizes High Radiology Costs

February 25, 2011
Written by: , Filed in: Medical Ethics, Practice Management
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“I have been extremely frustrated with the amount of fraud, waste, and abuse in outpatient radiology,” said the consultant.

And he’s a radiologist.

That’s not all he said:

There are primary-care physicians and businessmen, not radiologists, setting up medical-imaging centers and doing it badly. They make a lot of money, bill insurers, and are performing questionable practices.

The opinionated radiologist is Richard Chesbrough, MD, who works with Radiology Medical Consultants in Bingham Farms, Michigan, in suburban Detroit. He was quoted earlier this week in a Crain’s Detroit Business article headlined “Providers, insurers seek ways to reduce growing radiology costs.”

Does that sound ominous? It should. The article cites a 2008 study by the U.S. General Accountability Office, the investigative arm of Congress, that found an average annual growth rate of 17 percent since 2000 in health-care spending on CT, MRI, and PET. And it quotes the Congressional Budget Office as saying, also in 2008, that imaging costs have become “the fastest-rising cause of medical inflation.”

In other words, imaging costs are a great big target for cost cutters at all levels of the health-care system.

Dr. Chesbrough said his studies found that 28 percent of radiology tests billed by providers either were unnecessary or didn’t meet minimum quality standards. “There is an enormous amount of poor quality and overutilization,” he said. He continued:

Radiology used to be based in the hospitals, but it has moved out into the outpatient world because of changes in reimbursement. Now, 75 percent of all medical imaging is done outside of hospitals, and in that environment there is hardly any regulation.

Ouch. The R-word. “Regulation.”

The Crain’s article talks mostly about procedures being tried by health-insurance companies to reduce overuse of imaging. It also mentions that the Detroit-based Henry Ford Health System earlier this year received a $1.7 million grant from the federal Centers for Medicare & Medicaid Services “to evaluate the effectiveness of decision support systems used in the radiology testing preauthorization process.”

The two-year study will begin May 1 “with the goal of curtailing unnecessary medical imaging studies.”

Here’s the bottom line: if referring physicians, radiologists, insurance companies, and the rest of the health-care system can’t work together to reduce unnecessary and questionable imaging, the government will do it instead. If that happens, it might be good for some parts of the system, but not for radiologists.

Related seminar: The Business of Radiology

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