In August, I attended the 10th seminar, or summit, as they called it, organized by the American Board of Radiology (ABR) Foundation. The topic was “Medical Imaging: Addressing Overutilization in the Era of Healthcare Reform.” About 80 people attended, including ABR trustees; representatives of radiology groups; invited guests from other disciplines; a trustee of the American Medical Association; federal health officials including Medicare, the Veterans Administration, health insurance executives, physicists, a White House advisor, a consultant from the International Atomic Energy Agency; and people from other health research and study organizations. The conference was co-sponsored and funded in part by the National Institute of Biomedical Imaging and Bioengineering.
There were five keynote speakers: Robert Kocher, an internist and special assistant to President Barack Obama and a member of the National Economic Council; Bernard Rosof, chairman of the AMA’s Physician Consortium for Performance Improvement; James P. Borgstede, a current ABR trustee and past chairman and president of the American College of Radiology; James Thrall, current chairman of the American College of Radiology Board of Chancellors; and Paul Wallner, a new ABR associate executive director and previously a staff member of the National Cancer Institute.
Although the theme was medical imaging, the week in early August was a time when the Congress was being pushed to draft health care reform legislation. The White House was urging action this year and the Republicans and some of the private enterprises in health service were accusing the Democrats of not knowing what they were doing. Short of any federal legislation on health care reform, national spending has been increasing at about 15% yearly for the past decade. It now stands at 17% of the gross domestic product, will reach 20% in the absence of any action, and could amount to the total gross domestic product in 75 years. For Medicare, medical imaging now amounts to a fifth of all physician charges paid for by Part B. And imaging costs grew from $6 billion to $14 billion within the current decade.
Bob Kocher asserted that the three targets of the Obama general proposal were to (1) reduce the costs of all health care, (2) provide a free choice of physicians to all patients, and (3) create a system that would pay for affordable, quality health care for all Americans. He mentioned the high cost of drugs, tops in the United States, the charges for health care insurance, federal subsidies for health-related research, and the estimated 126,000 lives lost each year because of poor medical service in too many communities.
Bernard Rosof talked of the dozens of study groups, including the Institute of Medicine, which propose changes in health patterns. The increase in medical imaging is one of the targets for reform, he asserted. He noted the 2008 passage of federal legislation that would impose restrictions on other docs providing advanced imaging—computed tomography, magnetic resonance imaging, and positron emission tomography scanning—without demonstrating qualifications. There should be a demonstration project beginning next year and general implementation by 2012, unless Congress is persuaded to dump the requirement.
Jim Thrall observed that the growth in the volume of medical imaging does not necessarily represent overutilization. Part of the growth accommodates population growth and part of it reflects improvements in computed tomography, magnetic resonance imaging, and other imaging formats that benefit diagnosis and offset less effective other techniques. He noted that some of the growth resulted from increases in the self-referral of imaging by docs in other disciplines. He cited an estimate by David Levin that self-referral imaging costs an excessive $16 billion per year in unnecessary spending.
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