EXPERT INITIAL INTERPRETATION OF ADVANCED IMAGING SCANS SIGNIFICANTLY REDUCES DOWNSTREAM MEDICAL COSTS

Expert Initial Interpretation of Advanced Imaging Scans Significantly Reduces Downstream Medical Costs

Statement of problem: Purpose: The purpose of this study was to determine if there is a significant correlation between specialized radiologists interpreting advanced imaging studies (magnetic resonance imaging and computed tomography) and certain subsequent medical costs.

Description of the intervention or program: Methods: All patients covered under a  large metropolitan commercial health insurance plan and referred for an advanced imaging study during the period October 2008 to December 2009 were entered into the study. Patients were encouraged, but not required, to go to a Premerus facility for imaging. Premerus program facility and equipment standards specify that all studies be performed on up-to-date, high-quality equipment by well-trained personnel. Premerus radiologists must meet rigorous requirements and pass a case examination to determine their cognitive and reporting capabilities. During the 15-month period, data for 8,495 non-Premerus and 5,237 Premerus episodes were gathered. The first scan was termed the anchor episode, and all subsequent downstream costs attributable to that episode under the Ingenix Symmetry Episode Treatment Group^® (ETG) classification system were aggregated to that scan. Raw claims data were gathered for these patients and classified into episodes using ETG methodology. Medical intensity and costs related to those episodes were calculated and compared for the two groups, including: number of advanced imaging scans per episode; relative costs per episode; complete episode savings; services per episode; inpatient admissions; inpatient length of stay.

Findings to date: Results: Overall, Premerus-imaged patients realized lower costs in several specific areas: in-patient costs, imaging costs, and specialist physician costs. In-patient costs appear to be a significant driver of overall cost reduction in the Premerus cohort. These cost reductions appear to be related to a reduction in length of stay to a day and one half (1.5), or a 15% difference.  Premerus-imaged patients underwent  17% fewer total imaging procedures ; and their specialist physician costs were 18% less per episode. 

Lessons learned: Conclusions: Expert initial interpretation of advanced imaging is associated with reduced downstream healthcare costs. High-quality images are the foundation of a more accurate report. Subspecialty expertise compels a greater degree of interpreting confidence, leading to more precise reports and recommendations. Organization of radiologic interpretation around subspecialty reading holds significant promise for reducing downstream medical costs.