Medical Imaging: Addressing Overutilization in the Era of Healthcare Reform

ABRF-sponsored meeting, August 2009

The United States spends considerably more per capita on healthcare than other developed countries, yet life expectancy is lower in the U.S., and disease-specific mortality rates are higher. Excessive use of imaging procedures contributes the most by far to the upward trend in costs attributable to healthcare technologies. In fact, approximately 20 percent of the cost increase each year is related to imaging.

To address this critical issue, the American Board of Radiology Foundation sponsored a multidisciplinary national summit meeting, "Medical Imaging: Addressing Overutilization in the Era of Healthcare Reform," August 6-7, 2009 in Bethesda, Maryland. The summit was co-sponsored by the National Institute of Biomedical Imaging and Bioengineering (NIBIB) and the American Board of Radiology (ABR).

Approximately 90 invited participants from 55 different organizations were in attendance (see below). Through interactive presentations and breakout sessions, the summit provided a multidisciplinary forum to confront the many forces in our country that influence overutilization of imaging procedures:

• The education of physicians and the culture in which they work
• The fee-for-service environment of healthcare in the U.S.
• Lack of outcome data about the effectiveness of specific applications of imaging technologies
• Marketing of imaging technologies to physicians and directly to patients
• Patient expectations and preferences for high-tech medicine, including imaging procedures
• Defensive medicine
• Physician ownership of imaging facilities
• Insensitivity to healthcare costs created by a system of third-party payments for services

Participants identified some of the ways these forces can be controlled and changed through a collaborative national effort. William R. Hendee, PhD, chairman of the American Board of Radiology Foundation board of directors, is writing a white paper outlining the summit's conclusions and action items.

Speakers:

• James Borgstede, MD
  Associate Professor of Radiology and Vice-Chairman, Department of Radiology, University of Colorado School of Medicine, Denver
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• Robert Kocher, MD
  Special Assistant to President Obama and member of the National Economic Council, focusing on healthcare economics and policies
  
  
• Bernard Rosof, MD
  Chair of the Board of Directors, Huntington Hospital, North Shore-Long Island Jewish Health System; Clinical Professor of Medicine, New York University School of Medicine; and Chair of the Overuse Committee of the National Priorities Partnership
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• James Thrall, MD
  Radiologist-in-Chief, Massachusetts General Hospital, and Juan M. Taveras Professor of Radiology, Harvard Medical School
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• Paul Wallner, DO
  Associate Executive Director for Radiation Oncology, American Board of Radiology, and Senior Vice-President for Medical Affairs, 21st Century Oncology, LLC, and Radiation Therapy Services, Inc., Ft. Myers, Florida
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