Article Review on Overutilization in Medical Imaging
“Overutilization is defined as the application of imaging procedures in circumstances where it is unlikely for the patient’s outcome to improve.” The article points out factors that influence overutilization in medical imaging, and measures that can be
taken to reduce overutilization and improve the performance of imaging services.
Some of the factors highlighted by the article that contributes to overutilization include; providing patient-centered care, working in interdisciplinary teams, using evidence-based practice, applying quality improvement, and utilizing informatics.
To reduce overutilization in medical imaging, the article suggests that; one,
the appropriateness criteria for imaging should be regularly updated to enhance diagnostic reliance. Second is through the use and incorporation of practice guidelines in standards on appropriateness.
Third, it is through educating patients, referring physicians, and the general public.
The justification for the suggestions highlighted by the article is that if we have a more objectified idea about the patient’s signs/symptoms, the physician would have a better idea of how to treat the patient eliminating unnecessary diagnostic tests.
“Although publications suggest that 20-50% of imaging procedures fail to provide information that improves patient welfare and may represent unnecessary imaging services when calculating these percentages, they failed to account for the value behind negative imaging studies in influencing decisions about patient treatment and management”. In other words, it is just as useful to do an imaging exam and have a definite diagnosis as it is to do an imaging exam and have a negative one. The process of ruling out a particular diagnosis is essential to the entire diagnostic operation. It crosses off specific diagnosis from the list of possible or probable conditions that the patient may or may not have.
Self-referral is a procedure where the referring physician is also the service provider or has an ownership interest and benefits financially by providing the service. The conflict comes in when the self-referral and the conflict of interest with the referring physician because financial return from conducting the procedure may override the medical necessity of the procedure. The cost of unnecessary imaging procedures in the united states costs $16 Billion a year. Self- referral contributes to overutilization because a physician may take it upon themselves to order exams that may not be beneficial to the patient all for the sake of getting money.
Appropriateness criteria need to be updated periodically for medical imaging because it improves the spread of information or dissemination across the medical community. Objective clinical evidence is beneficial when directing patients through the many available imaging studies. Practice guidelines should be clear, consist, well-publicized, and easily accessible to patients. In line with this, patients should have access to information on options available so that they may make a clear and conscious medical decision for themselves and don’t have to count on the physician’s opinion entirely.
The fee for service payment process contributes to the overutilization of imaging services. The more procedures performed more revenue is incurred by the institution as well as the physician performing the procedure. The article suggests that if an approach towards rewards evidence-based care and preferred outcomes were to happen, it would be a health care system that is more cost-effective and value-based.