Commercial insurers spent at least $192M on low-value imaging in one year alone

U.S. commercial health insurers spent more than $192 million on “low-value” imaging in 2015 alone, according to a new analysis.

The finding was part of a larger exploration of healthcare waste, published by consulting firm Altarum. All told, the Ann Arbor, Michigan, agency estimated that payers spent about $5.5 billion on 20 different healthcare services “of little or no value to their members.” Those included $2 million for dual-energy x-ray absorptiometry tests repeated within two years, $8 million for coronary artery calcium scoring using CT, $12 million for scans to diagnose rhinosinusitis and $170 million for imaging of lower-back pain.  

“This work, while not a comprehensive assessment of all low-value care services, supports prior research that suggests the cost and prevalence of low-value services is a major problem,” the analysis noted.

Lead author Beth Beaudin-Seiler, PhD, an analyst at Altarum, and colleagues pinpointed 20 specific low-value services based on recommendations primarily derived from the Choosing Wisely campaign. They then identified such wasteful care using algorithms developed by Anthem, along with further data from the VBID Health’s low-value care task force (Value Based Insurance Design was also a partner in the research).

All told, the analysis included data from a single commercial payer covering 10 million lives, and spanning all 50 states and the District of Columbia. The results were then extrapolated across the entire commercially insured population to reach the final figures. Beaudin-Seiler and colleagues noted that waste estimates could have grown even larger, had researchers included any follow-up care, or data from public payers.

Across the study population, nearly 18% of members received at least one low-value service during the study period. Unwarranted routine annual pap smears led the way, reaching about 7% of members. Imaging of lower back pain, meanwhile, logged in at only about 0.8%, while repeat DXA scans, coronary artery calcium scoring (both 0.01%) and sinus CT (0.08%) all landed even lower. Altarum also included MR imaging of the peripheral joints to routinely monitor inflammatory arthritis on its list for this study. However, this practice—discouraged by the American College of Rheumatology—accounted for less than $1 million in spend across the U.S.

At the local level, the states with the lowest levels of low-value care included Alaska, North Dakota, Utah, Idaho and Oregon, with about 10% of members receiving at least one such service. Florida, New Jersey, North Carolina, New York and Alabama were the biggest offenders, logging in at 22%.

Beaudin-Seiler and colleagues did not analyze the drivers of this wasteful care. However, they believe addressing these practices will require a multifaceted response.

“It is clear that curbing the use of low-value care does not lie at the feet of any one driver,” the team concluded. “Changing provider behavior, systems, and patient behavior are all required and aligning various incentives among these players will be a meaningful way to address low-value care.”

Imaging of lower back pain, in particular, has been a persistent problem for radiology. One November study found that that emergency physicians were ordering thousands of such scans, despite evidence that they’re frequently unnecessary.

Editor's Note: This article has been updated to also include coronary artery calcium scoring using CT.