Utilization Corner: How to impact high-tech imaging trends and improve quality of care

Imaging tests such as MRI, CT, and PET are valuable tools for diagnosing and treating various health conditions. However, they also come with a high price tag and potential risks, such as radiation exposure and false positives. Overuse of imaging can contribute to the rising total cost of care and affect the quality and safety of patient care.

According to our network data, our high-tech imaging rates have increased significantly in the past year and our performance is worse than Milliman Health Cost Guideline™ benchmarks for MRI, CT and PET scans. Imaging occurs across a broad range of diagnoses; the top three in 2023 were headache, unspecified abdominal pain, and multiple sclerosis.

Blue and gray graph showing upward network performance

We understand that imaging decisions are not always straightforward and may depend on various factors, such as patient preferences, clinical judgment, and availability of alternatives. That is why we are here to support you and your patients in choosing the right care at the right time in the right place. The following resources can provide guidance and best practices to make informed and evidence-based decisions for imaging to ensure that patients receive the most appropriate and effective care possible.
  • LHP’s clinical guidelines are based on the latest research and expert consensus for established clinical pathways and best practices. You can find current guidelines on the LHP Team Site that offer recommendations for imaging for headache, joints (shoulder/hip/knee), and dementia. A password is currently required to access LHP’s guidelines, but we are committed to making our collection of resources more accessible to providers to use. We will notify you once these resources are available without requiring a password to access.
  • Choosing Wisely is an initiative that aims to reduce waste and overuse in health care by encouraging informed decision-making based on evidence. It sparks discussions between clinicians and patients regarding tests and procedures that are commonly done but not always necessary, as well as patient education materials and conversation starters. You can access Choosing Wisely resources on their website, app, or through your medical society.
  • The American College of Radiology (ACR) offers evidence-based guidelines (for adults and pediatrics) called Appropriateness Criteria to assist providers in selecting the most appropriate imaging test for a given clinical condition. You can view the Appropriateness Criteria interactive portal including topics, variants, clinical scenarios, and recommendations to find the best imaging option for your patient.
  • Computerized decision support tools can aid in making informed imaging decisions, ensure the most appropriate test is chosen, and reduce the likelihood of unnecessary procedures.

We appreciate your commitment to providing high-quality and cost-effective care to the patients in our network. Together, we can reduce unnecessary imaging and improve the health and well-being of our community.