Advanced medical imaging technology like MRI has had an extraordinary impact in patient care. In fact, most physicians can’t imagine practicing without these life-saving tools. The cost of MRI and CT accounts for less than 3% of healthcare spending in the United States and yet the use of these tools is often cited as a reason for the rising cost of healthcare. This provides motivation for the radiology community to understand and optimize the value of these technologies in patient care. The extraordinary diagnostic capabilities provided by MRI are well-recognized, and this is reflected in the fact that in the US, MRI is well-reimbursed in the fee-for-service system. MRI practice in the US typically employs large, comprehensive (rather than focused) scanning protocols, designed to address many different indications. Several factors may contribute to this situation. The standardized classification of medical procedures in the form of CPT codes in the US provides only a few “billable” CPT codes for MRI examinations of each part of the body – far fewer than the number of unique indications for each exam. Medicolegal concerns may also contribute to the use of comprehensive rather than focused MRI protocols, as well as questions about eligibility for reimbursement when anything less than a full comprehensive MRI protocol is used. The reliable reimbursement provided by standard comprehensive MRI protocols does little to encourage innovation in the denominator of the value equation. Another factor affecting this situation in the US is massive cost-shifting within the medical care system. For many medical organizations, MRI represents a vital source of net revenue that can be used to offset losses incurred in other areas of the practice. But change is coming in the US. There is a steady trend towards systems of bundled payment and population-based capitated care. If these models expand to eventually replace most fee-for-service imaging, then MRI could become a pure cost-center. Without a healthy reimbursement stream, the radiology community may not be able to justify the excess services that might be embedded in current system of comprehensive MRI protocols. In addition, there is a risk that medical decision makers may not fully recognize the substantial difference between “charge” and “cost” in the current system. Faced with the need to control costs in a population-based capitated system, they may base guidelines for use of MRI on an inflated notion of the cost of the procedure. This could inappropriately reduce patient access to MRI. A better future might be achieved if radiology takes a lead in optimizing the value of MRI. There is no doubt that our researchers will continue to advance our imaging capabilities. Much of the innovation in MRI in the past has focused on the numerator of the value equation, by increasing the amount and quality of diagnostic information provided by MRI. But there will be even more opportunity if the radiology community deliberately moves to focus its innovators on relentlessly optimizing denominator of the value equation.

Acknowledgements

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References

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