Did you know that an excessive amount of body fat damages the quality of images that you would get from using a CT or MR scanner? In order for a scan to be successful and the images to be precise, the x-rays must be able to infiltrate through layers of skin, tissue and fat. Since all body tissue absorbs and averts a certain amount of the x-ray waves, it is even more difficult to capture accurate data and images for people who are severely overweight. More than one-third of U.S. adults (35.7%) are obese, according to Centers for Disease Control and Prevention, and there is no doubt that that number will continue to increase. This disturbing statistic has forced companies to accommodate for these patients in a few different ways:
Due to life-saving technological advances and new applications of existing technology, medical imaging experienced a marked increase in utilization and spending from 2001 to 2005. Imaging became central to good medical practicedecreasing the need for invasive surgical procedures and delays in diagnosis. Better computer technology and breakthroughs in clinical applications enabled doctors to better target many treatments and eliminate others that became unnecessary. Among these technologies are PET and CT scans.
The Deficit Reduction Act (DRA)
Despite the advances in technology, Medicare reimbursements for medical imaging services have been cut eight times since 2006. Per beneficiary spending on advanced imaging services (often singled out for payment cuts by federal policymakers) has declined by 27.6 percent. This decline does not line up with the perception among some policymakers that Medicare spending on imaging services is growing. In 2007, the Deficit Reduction Act (DRA) reduced payments to imaging dramatically. The Congressional Budget Office (CBO) estimated $500 million in reimbursement cuts to medical imaging, but after implementation, the total was nearly $1.6 billion. Cuts are planned to continue through 2013.
In 2006, at its peak, imaging spending was 13 percent of Medicare carrier paid claims. However, in 2011 it dropped to only 9.3 percent. Medicare devoted a smaller portion of spending to imaging in 2011 than at any point in the last decade. The rate of imaging growth relative to the overall Medicare program was a key factor, cited by policymakers, in targeting medical imaging for reimbursement cuts in the past.
Medical Imaging Utilization
A year-over-year decrease began in 2010 for the utilization of all imaging technology services. This means Medicare beneficiaries received fewer scans per beneficiary than in the previous year. Despite new clinical applications of imaging technology and evidence of the role of imaging in reducing healthcare costs, this decline in Medicare beneficiaries use of medical imaging services has continued. The contrast between the proven value of imaging and its declining use raises serious concerns that further payment cuts may threaten access to appropriate medical imaging for many Medicare patients.
The decline can also be attributed to advancements in the education of physicians on appropriate imaging. As physicians use guidelines on imaging, they are better able to discuss the benefits and risks of imaging with patients and their families to make informed decisions about the best path forward.