Where’s Aimee when you need her?

Last week I posted about Aimee, a web-based tool that allows patients and physicians to understand the radiation exposure they’re receiving from various medical scans. The site also suggests alternative scans that may be more appropriate (and less expensive) in specific situations. I also interviewed the CEO of SafeMed, a company whose real-time clinical decision support software provides patient-specific guidance on imaging and other tests at the point-of-care.

A MedPage Today article provides a reminder of why such tools are so important. See Physician Self-Referring Linked to Spike in Imaging Use.

Physician self-referral for CT, MRI, and PET scans accounts for much of the large recent increase in overall usage of these technologies in California, said a researcher here.

Overall utilization of MRI scans in California increased by about half from 2000 to 2004, but scans performed by physicians who billed for the procedures themselves rose as much as 374% among some patient groups, reported Jean M. Mitchell, Ph.D., of Georgetown University in the May issue of Medical Care

Dr. Mitchell said the most likely explanation for the dramatic increases in self-referred imaging was financial.

“For many cases, use of an advanced imaging procedure in lieu of a less expensive diagnostic procedure results in higher revenues (profits) to the provider without any commensurate improvements in outcomes or quality,” she wrote.

The AuntMinnie article I cited listed a variety of criticisms and quibbles from physicians about Aimee, one of which was that the tool is provided by a cost containment company that has a financial interest in imaging utilization. It’s a bit like the pot calling the kettle black.

I expect that all of this will evolve to a model where providers deploy SafeMed and similar tools, which contain protocols and decision rules that both providers and payers can accept. That will reduce the friction between payers and physicians while improving outcomes and safety for patients and lowering costs along the way. That era can’t arrive too soon as far as I’m concerned.

April 28, 2008

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