Is it appropriate? 3 sources of wasteful imaging in Washington state

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Over the course of a single year, $282 million was spent on wasteful healthcare in Washington state, according to a new report published by the Washington Health Alliance. Unnecessary imaging services made up a significant amount of that total.

The report, “First, Do No Harm: Calculating Health Care Waste in Washington State,” examined insurance claims data for services provided between July 2015 and June 2016. The Washington Health Alliance ran the data through its Health Waste Calculator tool, which was “designed to help identify and quantify overused health care services as defined by national initiatives such as the Choosing Wisely campaign and the U.S. Preventive Services Task Force.”

The report looked at $785 million total in healthcare spending, covering more than 1.5 million separate services. Thirty-six percent of that total ($282 million) was found to be spent on “low-value services.”

The 27-page report calls out wasteful imaging services numerous times. Based on the authors’ research, these are three significant sources of wasteful imaging.

1. Eye imaging ($33.8 million)

Based on Choosing Wisely recommendations, 74 percent of all individuals who received imaging for eye disease received low-value care. This represents an estimated cost of $33.8 million.

Physical examination of a patient’s eye or the patient’s comprehensive medical history is typically enough for physicians to make their diagnosis without clinical imaging tests, according to the report.

“This measure identifies eye imaging tests (posterior and anterior optical coherence tomography, fundus photography, visual field testing, external or internal eye photographs) in the absence of significant eye disease as wasteful,” the authors wrote. “In this analysis, less than four percent of patients who received eye imaging had a diagnosis of diabetes.”

Overall, imaging for eye disease data included more than 104,000 patients and an estimated total cost of $46.4 million.

The analysis did not include neuroimaging.

2. Imaging for uncomplicated headache ($6.7 million)

Again turning to Choosing Wisely recommendations to analyze imaging data for “patients with uncomplicated headaches.”

“Headache is often misdiagnosed or mistreated,” the authors wrote. “Several studies have confirmed that imaging for isolated headache unaccompanied by other neurologic findings does not contribute to better management of the patient.”

Fifty-three percent of all imaging for uncomplicated headache was found to be wasteful, with less than one percent being viewed as likely wasteful. The wasteful imaging covered more than 4,800 patients and an estimated cost of $6.7 million.

Overall, imaging for uncomplicated headache data included more than 9,000 patients and an estimated total cost of $12.6 million.

3. Imaging for low back pain ($4 million)

Based on Choosing Wisely recommendations, the study determined that imaging for low back pain within 42 days of diagnosis was wasteful. Overall, 18 percent of all imaging for low back pain in the state was found to be wasteful, 17 percent was necessary, and a whopping 65 percent was likely wasteful. The wasteful imaging had an estimated cost of $4 million.

Overall, imaging for low back pain data included more than 16,600 patients and an estimated total cost of $4.8 million.

“Clinical experts agree that the potential harm associated with premature imaging in patients with low back pain outweighs the benefits; imaging can reveal anatomic abnormalities that are unassociated with the pain—but the identification of the abnormalities can lead to unnecessary treatment, including additional imaging and surgery, driving up costs and increasing the risk of harm to patients,” the authors wrote.

The full report is available here.