Addressing Over-Use by Reducing Diagnostic Imaging Services

The quality crisis is generally described as consisting of:

• Under-use
• Mis-use, and
• Over-use.

Addressing under-use has generally been greeted with universal support, as increasing use of high value services makes sense to employers and purchasers and generally increases revenues for providers and  health care organizations because more services are provided.

Addressing mis-use has generally been philosophically supported because, after all, how can someone morally support harming people in the system? Although philosophical support has been there, what to do to reduce or eliminate mis-use has been very controversial and progress has been slow.

But, work on over-use has been almost non-existent. Reducing over-use will directly impact health care organization's revenue. But now that cost has reared its head again as a major issue for purchasers, reducing over-use of services that provide little to no clinical value is back on the front burner.

In November 2008, the National Priorities Partnership, a group of 32 organizations convened by the National Quality Forum, announced 6 priorities, including reducing "overuse" of services that provide little to no clinical value (click here to learn more about all 6 priorities). The Partnership actually listed potential areas of over-use that should be addressed.

The over-use that seems to be front and center is diagnostic imaging. Significant work is being conducted
in both Washington state and Minnesota. Click here to read Bruce Seigel's (National Director of the Aligning Forces for Quality project) blog post on how organizations in these states are addressing overuse of imaging services by publicly reporting physician use of imaging services and establishing community-wide standars for appropriate use of imaging.