Case Study 5: Over-utilization of Imaging Services

Challenge:
For patients and clinicians alike, the availability of the computed tomography (C-T) scanner, magnetic resonance imaging (MRI) machine and positron emission tomography (PET) scan have completely revolutionized medical care and helped to improve medical decision-making and patient outcomes. The bad news is that, with the progressive reliance on these expensive diagnostic tools, the cost of care has increased significantly. Many clinicians, including radiologists, believe that at least 50 percent of scans done today in the U.S. are unnecessary. In lieu of good medical judgment, excessive scanning results in clinical "findings" that often result in additional scans and procedures with attendant morbidity.

Actions Taken/Approach to Solutions:
At Beth Israel Deaconess Medical Center, where reducing the annual number of imaging orders is a top priority, we tracked and segmented every high-tech scan by category, doctor and diagnosis. We identified patterns of overuse, such as for joint pain, headache and back pain, and relentlessly educated clinicians about more judicious use of imaging.

Results:
We used our primary care structure to transparently share data among groups. We sharply bent the cost curve downward for advanced imaging orders resulting in improved quality of care and decreased cost. (Actual numbers for these changes are proprietary; therefore, are not provided.)

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