Insurers Increase Oversight of Medical Scanning Tests

The "soaring use of scanning tests" is joining prescription drug costs as a main culprit behind the rise in health care costs, USA Today reports. The increased frequency of these tests, used to detect heart disease, cancer, fractures and thinning bones, is forcing managed care companies to re-evaluate their coverage of these procedures. Some insurers report that the use of X-rays, magnetic resonance imaging (MRI), computed tomography (CT) scans and some cardiac tests have increased 15-20% a year. According to USA Today, this growth is being caused by an aging population, new and improved technology, patients "demanding the tests after seeing advertising and time-pressed doctors looker for quicker diagnoses." In an attempt to control costs, several insurers have hired "outside firms" to help determine which patients should qualify for certain procedures. New Jersey-based National Imaging Associates, for instance, assists 18 insurance companies in managing radiology services. One of its clients, Blue Shield of California, has used National Imaging in the past year to authorize "non-emergency diagnostic scans." Blue Shield Senior Medical Director Frank Apgar said this oversight enhances patient safety. "With CT scans, there's a significant amount of radiation. It's important for patients to discuss this with their doctors," he said. In the first year that approval was required, 10-14% of requests for scans were either denied or withdrawn, which may be an indication of how many were unnecessary, according to USA Today. Dietder Enzmann, head of radiology at Chicago's Northwestern Memorial Hospital, does not believe, however, that tests are being ordered without cause. "The unlikely explanation is that physicians have suddenly decided to order exams on a whim. I don't see a great deal of tests being ordered that don't seem to be indicated," he said (Appleby, USA Today, 11/21).