4 The Economic and Regulatory Impact of Evidence-Based Medicine on Radiology

Key Points

US healthcare expenditures have nearly continuously increased over the past 40 years, not only in real dollars, but also in almost every other measurable term. If current rates of increase were to continue, long-term growth in medical spending would eventually consume all growth in per capita income and in 30 years, more than one third of the US gross domestic product (GDP) would be devoted to healthcare costs. According to some analyses, much of the stagnation of standard of living of the working-class can be explained by the continued rise in medical costs, without which American working families would continue to enjoy a rising standard of living. Most other industrialized countries routinely use cost-effectiveness analysis (CEA) to improve the value of medical care, decreasing both inappropriate underutilization and overutilization. Example of overutilization: self-referral. From 2001 to 2006, the volume of CT imaging performed at in-office facilities owned by radiologists rose by 85%. The volume of imaging performed at in-office facilities in which nonradiologist referring clinicians had a financial stake rose by 263%. Some physician groups have had success both lowering costs and improving quality. Whatever their organizational structure, the so-called accountable care organizations tend to have certain elements in common: physicians and hospitals tend to have a close working relationship, most of them use electronic medical record systems to track and improve care, and they generally encourage a culture of restrained spending and collaboration with competitors for the benefit of patients. The two main thrusts of policy makers’ efforts are (1) to pay for appropriate care that, based on the evidence, is most likely to improve health outcomes, and (2) to encourage providers to work more closely together to make sure that evidence-based care is provided consistently and efficiently. Ideas that are taking root include decreasing reimbursement, using third parties to help decrease inappropriate imaging, and changing the reimbursement incentive structure. The recently enacted US healthcare reform statute has two main priorities: to expand coverage and control costs. While the coverage provisions of the act have received the majority of the attention in the press, the second priority of the statute, that of cost control, probably has more potential to affect radiologists and other physicians. The challenge has been issued to the medical community, including radiology, to move evidence-based imaging (EBI) from a theory or a collection of anecdotes to one that can be effectively implemented on a broad scale.

Parts of this chapter used with permission of the ARRS from ARRS 2010 Categorical Course: The Financial and Regulatory Aspects of Evidence-Based Medicine, 2010.