Cutting costs and improving care not mutually exclusive

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While an article in the latest issue of Time rather sensationally explored the problem of rising medical bills, we also recently were reminded that physicians--including those associated with medical imaging--are trying to do their part both to keep costs down and to protect and enhance their patients' health.

As part of the Choosing Wisely campaign, 17 medical specialties issued a list of procedures they've identified as frequently unnecessary, and often harmful. As described in FiercePracticeManagment, the recommendations include several related to medical imaging.

For example, the American Academy of Pediatrics recommends that physicians should avoid automatically using CT scans to evaluate children who show up at emergency departments with minor head injuries or abdominal pains. CT imaging is increasingly used to evaluate children with abdominal pain, and up to 50 percent of children who present with head injuries undergo CT scans, so following these suggestions would certainly decrease the number of children unnecessarily exposed to the radiation associated with this exam.

The Society of Cardiovascular Computed Tomography, meanwhile, suggests that physicians refrain from routinely ordering coronary computed tomography angiography for screening asymptomatic patients, or for high risk emergency department patients presenting with acute chest pain.

And the Society of Nuclear Medicine and Molecular Imaging recommends that physicians refrain from order PET/CT for cancer screening in healthy individuals. The likelihood of finding cancer in those individuals is extremely low, based on studies using PET/CT screening, and could lead to the identification of harmless findings that, nevertheless, result in more tests, biopsies or unnecessary surgeries. SNMMI also recommends that PET not be used to evaluate patients with dementia, unless the patient has been assessed by a specialist in the field.

As suggested by the SNMMI in the case of PET and dementia patients, there are both health and cost considerations associated with these recommendations. If followed, these suggestions would certainly save billions of dollars in spending annually.

One of the driving ideas behind the Affordable Care Act is to cut costs and improve care. Radiologists and other physicians are showing these objectives are not mutually exclusive. - Mike  @FierceHealthIT