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A new analysis of 2010 Medicare claims data shows that spending on medical imaging continues to decline and that Medicare patients are actually receiving fewer imaging procedures-debunking the myth that life-saving diagnostic imaging exams and radiation therapy are increasing health care costs.

The Medical Imaging and Technology Alliance (MITA) conducted the analysis-based on data tabulated by Direct Research LLC-to determine the impact of reimbursement cuts to medical imaging over the last five years on spending and utilization.

Contrary to policymakers' faulty perceptions of steady growth in imaging, the data show that spending on imaging services for each Medicare beneficiary has dropped 13.2 percent since 2006, when significant imaging-specific reimbursement cuts from the Deficit Reduction Act began to be implemented, and imaging utilization per beneficiary declined by 3 percent in 2010. Meanwhile, spending for non-imaging Medicare services has grown by 20 percent since 2006 and utilization increased 2 percent in 2010. The analysis also found that imaging is now a smaller portion of Medicare spending than it was in 2000.

Despite these significant downward trends in spending and utilization, imaging continues to be a target for cuts. In fact, Congress and the administration have cut imaging reimbursements seven times in six years, with payments for some services being reduced by over 60 percent, including bone density screenings, arm and leg artery X-rays, and brain MRIs. These cuts hurt access and undercut the benefits of early detection, making it harder for doctors to access these life-saving technologies.

Spending per beneficiary for imaging services in Medicare carrier payments has declined by 13.2 percent since 2006 (to $364/beneficiary in 2010). chart/courtesy MITA

Policymakers continue to propose further reductions to Medicare reimbursement, including a new prior authorization program that would take medical decisions out of the physician's hands and create additional hurdles between patients and prescribed services. Proponents claim that prior authorization and radiology benefit managers achieve long-term cost savings, yet no research supports this. Rather, prior authorization often simply means delaying or denying care; in a recent AMA survey of 2,400 physicians, 63 percent said that they typically wait several days for a response to a prior authorization request and 13 percent said they wait more than a week.

Recently, the leaders of the congressional supercommittee tasked with finding at least $1.2 trillion in deficit reductions weren't able to reach a bipartisan agreement before their pre-Thanksgiving deadline. Still, the threat of further cuts to medical imaging looms, as Congress continues to work toward an alternative to avoid the automatic cuts that would start in 2013 as a result of the supercommittee's failure to strike a deal.

As Congress continues seeking a balanced approach to deficit reduction, they ought to be aware of the facts. MITA's analysis of Medicare claims data disproves the assumption that diagnostic imaging and radiation therapy are driving health care costs. The reality-which millions of Americans undergoing treatment for cancer and other diseases know all too well-is that diagnostic services are essential to earlier detection, saving lives and preserving quality of life. Furthermore, it is because of advanced medical imaging that life-threatening health conditions can be caught early and treated sooner-preventing the need for longer, more costly treatments for Medicare beneficiaries due to late-stage diagnosis.

In a time of tremendous technological advances, it's unsettling to see such accelerating declines in Medicare beneficiaries' use of medical imaging services. Despite imaging's proven value in saving lives and reducing health care costs, dramatic cuts have taken a significant toll on patient access, and this trend cannot continue. Additional cuts and implementation of a prior authorization policy will only further jeopardize access to needed health care.

Further cuts are also expected to have a real impact on jobs in the U.S. The medical imaging industry produces innovative technologies that support thousands of middle-class Americans, while revolutionizing the standard of care for patients globally. In addition, further cuts also would force many freestanding medical imaging providers to close down and consolidate imaging into large hospital centers.

There are alternative approaches to managing utilization of imaging. Instead of indiscriminately cutting reimbursement and placing impediments between patients and diagnostic and screening services, the use of evidence-based, physician-developed appropriateness criteria should guide proper use. Appropriate use criteria programs with clinical decision support and education are effective and successful in driving quality care without compromising access, say a host of studies.

The data are telling and can't be ignored: Both spending and utilization are declining in Medicare. In the coming months, it's vital that policymakers refer to the most up-to-date information when making budget decisions that will affect patient access to life-saving imaging technologies and quality of care.

Dave Fisher is executive director of MITA.

This column is produced in conjunction with MITA, a division of the Association for Electrical & Medical Imaging Manufacturers. MITA is the collective voice of medical imaging and therapy equipment manufacturers, innovators, and product developers. For more info, visit www.medicalimaging.org.