Some Research on Repeat Imaging May Overestimate Waste

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Waste due to needless duplication of health care services and tests is gaining increasing attention by health care policy makers and payors. But what exactly is waste and what is necessary and medically appropriate is not always easy to determine in large population studies that rely on administrative claim data to note cases of repeat testing and services.

Concerned about the influence of studies on repeat imaging done with data that offer little detailed information on why exactly a test was repeated, the ACR’s Harvey L. Neiman Health Policy Institute today released a proposed structure for classifying different types of repeat testing in studies seeking to quantify the amount of inappropriate imaging currently occurring.

The structure splits repeat imaging into four categories: supplementary imaging, duplicate imaging, follow-up imaging and unrelated imaging. These are then divided into subcategories that drill down on why doctors repeated imaging tests on the same anatomical site. It looks like this:

Category Code Imaging Type
I. Supplementary Imaging
I.a High Value Added
I.b Low Value Added
II. Duplicative Imaging
II.a Intentional Duplication
II.b Unintentional Duplication
III. Follow-up Imaging
III.a Recommended Screening
III.b Standard Follow Up or Surveillance
III.c Non-standard Follow Up or Surveillance
III.d Inaccessible Prior Imaging Information
IV. Unrelated Imaging
IV.a Unrelated Event

What repeat imaging means in the real world as experienced by physicians and clinicians is not always the same as what repeat imaging means to a number cruncher just looking at claims data said report author Richard Duszak, MD, FACR, in a call with media announcing the report.

He cited as an example a patient with appendicitis in an early stage that requires a repeat CT when the appendix is more swollen for a correct diagnosis, as well as the hypothetical case of a cancer patient who is in a car accident and requires imaging in the emergency room that repeats imaging tests done just a day or two before due to their cancer.

“It really gets down to information that I think is going to to minable in electronic health record systems,” Duszak said. “A lot of it is going to be very nuanced information ... the more granular the information, the better we are going to be able to do this.”

Under each repeat imaging category and subcategory, the authors give an example and suggest a remedy, if one is needed.

The system is geared toward researchers, but Duzack was hopeful it would also be a starting point for conversations with anyone involved in reducing waste in health care, including payors. It might even be a useful structure for other medical specialties seeking to sort unnecessary repeating of testing and services from that which is necessary and important.

“Our goal is to continue to move the conversation forward,” he said.

To read the report, click here.