Health plans attempt to rein in radiology costs

While prescription cost increases have moderated, radiology costs grow almost 20% a year, according to new research from HealthLeaders-InterStudy

7 February 2005

NASHVILLE, USA. HealthLeaders-InterStudy, a leading provider of managed care industry intelligence, finds that health plans are taking steps to rein in the cost of radiology. According to findings in the recent Health Plan Data and Analysis reports, while prescription drug costs and hospital-payer contracts have received the most attention in the past five years, radiology costs have been growing at a remarkable rate.

"Radiology accounts for only 10 cents of each medical dollar spent by health plans," according to HealthLeaders Research Market Analyst Jane DuBose. "But the segment is growing by 18% to 20% a year. In contrast, interventions in prescription drug management by health plans have slowed the growth rate of pharmaceutical costs to below 10% in some cases."

To battle the issues of duplication and overuse of expensive imaging, health plans are using precertification and radiology copays and dictating guidelines for physicians. Health plans may also require that imaging studies be performed according to guidelines from the American College of Radiology or other organizations.

"Central to radiology management is data gathering, which shows when providers' ordering and denial rates are outside the norm," continued Ms. DuBose. "We expect more sophisticated use of data as vendors and health plans consider ways to reward quality and try to uncover why costs vary so much by region."

Demographic trends and continued technological advances will also mean higher utilization in the future; cardiac imaging expected to be one of the next big areas of medicine.

Source: HealthLeaders-InterStudy

CONTACT: Elizabeth Marshall of Decision Resources, +1-781-296-2563,
emarshall@dresources.com

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