"There is a definite concern that in-office imaging could lead to scanning for dollars,"

Health Insurers Limit Advanced Scans | Sunday, March 23, 2008

TRENTON, N.J. - Insurance companies are taking a harder look at advanced medical scans like CT scans, citing spiraling costs and safety concerns. And some doctors agree there's emerging evidence that these scans are being over-prescribed.

"Costs are soaring in this area, quality concerns are mounting and safety concerns are mounting," said Karen Ignagni, chief executive officer of the trade group America's Health Insurance Plan.
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Doctors, too, are concerned about patients getting excessive radiation exposure when they receive scans that aren't needed or are ordered as "defensive medicine" to protect against possible lawsuits. There also is concern that a small number of unscrupulous doctors without adequate expertise are referring patients for tests in their own offices or imaging facilities in which they have a financial interest.

"There is a definite concern that in-office imaging could lead to scanning for dollars," said Dr. Robert Hendel, a heart specialist who sits on American College of Cardiology panels focused on quality and appropriateness of imaging. ...
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The two doctor specialist groups are fighting improper use of scans by supporting accreditation of the machines and doctors using them and by publicizing criteria for quality and appropriateness of various imaging tests.

"There is substantial evidence that these types of techniques, when used appropriately - and I want to emphasize the word 'appropriately' - can keep the lid on expenses and improve outcomes," such as by catching cardiac problems early enough to prevent a heart attack, Hendel said. ...
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The insurer restrictions seem to be working: After one health plan that was seeing 20 percent annual jumps in advanced imaging use began requiring preauthorization, its growth rate plunged. Yet the insurer said only 1.5 percent of requests were being denied, indicating doctors were ordering fewer tests, according to the report. ...