Advanced imaging, including the magnetic resonance imaging (MRI) and computed tomography (CT) scans frequently used in workers’ compensation, help physicians diagnose workplace injuries and develop effective treatment plans. Numerous studies show that advanced imaging has improved medical outcomes in the areas of declining mortality, reduced need for exploratory surgery, and fewer and shorter hospital stays. It is no wonder that, by the early 2000s, advanced diagnostic imaging was one of the fastest growing components of healthcare costs.
From 2000 to 2006, Medicare’s spending on MRIs, CTs, nuclear medicine and Positron Emission Tomography (PET) scans increased from $3.6 billion to $7.6 billion – more than a 100% increase in a few short years.
These skyrocketing costs prompted Medicare to drastically cut per-unit reimbursements of imaging studies and to enlist utilization review solutions to ensure that all delivered tests were medically necessary. The workers’ compensation industry soon followed suit as state after state drastically lowered their fee schedules for these services.
Today, unit costs for advanced diagnostic imaging services are well managed by both Medicare and Workers’ Compensation – but managing unit cost is not the only important factor in managing the quality of patient care and overall claims costs. The reduction in reimbursement for MRIs and CTs has actually served to create new, increased quality and overall cost concerns.
If unit cost and utilization are under control, what else is there? How have unit cost controls negatively impacted quality and total costs?
As reimbursement rates decrease, imaging centers look for ways to reduce their operational costs and increase productivity, while dealing with limited funds to replace aging equipment. The pressure to do more with less, with existing equipment, is further exacerbated by the “need for speed” –especially in the world of workers’ compensation, where injuries are often the result of trauma and a timely diagnosis is vital to the restoration of an injured worker’s health and ability to earn a living.
Recent studies show that when radiologic studies are retrospectively audited, error rates are estimated to be as high as 30%. In addition, aging equipment is impacting the diagnostic quality of the resulting studies even when the right study is requested.
Much time and research has gone into analyzing the different types of errors that occur in diagnostic imaging. Recent studies have identified two general categories of errors that lead to diagnostic adverse events (DAE). The first is cognitive or knowledge-based errors. The second is system or process related errors.
As payers, providers, health care organizations and managed care companies, it is our responsibility to help minimize the risk of error in the areas which we can most effectively impact. Fast scheduling, controlling unit cost and utilization is not enough to optimally influence medical outcomes or total medical spend.
Click here to learn more about the controllable risk factors that continue to impact your medical costs – even after unit cost and utilization are under control.
MedRisk has been specializing in managing medical care for injured workers since the early 1990’s. They are known for their innovative approach and clinically based solutions for the workers’ compensation community. For more information on MedRisk’s diagnostic imaging programs, visit www.medrisknet.com/managed-diagnostic-imaging.
This is a sponsored post from WorkCompWire marketing partner MedRisk.
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