We received a question recently from the director of imaging at an institution that is planning to restructure hospitals services consistent with a center of excellence (COEs) strategy. The organization will be forming several different COEs for key service lines, including oncology, cardiovascular services, orthopedics, and others. The question posed was, what does such a COE strategy mean for imaging services? Should the department physically redistribute their equipment in some way? How can the imaging department measure their contributions to each COE? I wanted to provide some of my thoughts below.
Implications of COE Strategy for Imaging
An article published today in The New England Journal of Medicine, and the accompanying editorial, are going to bring the debate around mammography back into the spotlight. Findings from the article indicate that recent advances in the treatment of breast cancer have had a bigger impact on reducing breast-cancer mortality then screening mammography and the actual impact of screening mammography on breast cancer mortality is quite low.
New Study Questions Value of Mammography in Reducing Mortality
As revealed in a report issued by the Centers for Disease Control (CDC) last week, the use of advanced imaging (CT, MR or Ultrasound) on patients presenting the ED with abdominal pain was up 122% and up 368% for those presenting with chest pain in 2008 as compared to 1999. In 2008, 16% of patients presenting with chest pain and 44% of those presenting with abdominal pain received advanced medical imaging. While ED visits were up 22% overall, the percent presenting with chest pain actually decreased 10%. In contrast, abdominal pain visits increased 32%. Many reasons could account for this rise in utilization such as the increasing availability and awareness of imaging or a rise in defensive medicine practices. And, given that neither patient acuity nor the percentage of serious diagnoses rose over the 10 year period, it is likely that a large portion of this imaging was not necessarily appropriate.
New Census Shows Volatility in Imaging Center Market