Imaging companies aim to make worth clear

Medical imaging companies want to give regulators a clearer picture of their work.

Stung by criticism from insurers and hospitals that costs are out of control for magnetic-resonance imaging and other scans, equipment makers including Siemens Medical Solutions USA Inc. and Philips Medical Systems of Andover are fighting back, saying that the techniques pay off in better healthcare overall.

The companies point to several recent studies that suggest their technologies aren't major drivers of hospital cost increases. More research would be useful, but at least the companies have found allies among radiologists who use their equipment.

One is G. Scott Gazelle, a Massachusetts General Hospital radiologist, a board member of the American College of Radiology, and co-author of a study published in the journal Radiology in May.

The study found the costs of imaging procedures at Massachusetts General Hospital grew at 8.3 percent a year from 1996 to 2002, hardly different than the 7.8 percent that total hospital costs grew. And while it's true that doctors are ordering more imaging procedures, these often lead to better treatments that cut costs in other ways like reducing hospital stays, Gazelle said.

''It's hard to say that, at least in these conditions, that imaging was driving costs," Gazelle said, adding that ''It's still fair to say that the development of modern imaging is one of the most profound changes in healthcare in the last century."

Imaging refers to new scanning technologies like magnetic resonance imaging and computed axial tomography. The latter, for instance, sometimes known as a CAT scan or CT scan, refers to systems that use X-ray images taken at various angles around the body, then processed via computer to create a cross-sectional picture of tissue useful for spotting cancer or trauma injuries.

Lately the number of these procedures has soared. IMV Medical Information Division, an Illinois market researcher, found that 50.1 million CAT scan procedures were done at more than 7,350 US facilities in 2003, up 10 percent from 45.4 million procedures in 2002. The use of MRI procedures also rose 10 percent during those years, to 24.2 million in 2003 up from 21.9 million in 2002, the company found.

Spending is rising with usage. Diagnostic imaging services nationwide grew faster than any other type of physician service between 1999 and 2003, according to the Medicare Payment Advisory Commission, which makes recommendations about how much the federal program should pay for procedures.

Services rose 45 percent in those years compared to 22 percent on average for all services. In dollar terms, spending on imaging services rose to $9.3 billion in 2003 from $5.7 billion in 1999.

The commission reported the figures in March as it was urging rule changes to reduce the rate of growth. Some reforms were meant to reduce the financial incentives doctors have to order more procedures. Already some insurers are limiting how many imaging procedures they will pay for. Last year, for instance, a Pennsylvania Blue Cross Blue Shield provider, Highmark, took steps after costs for procedures rose more than 20 percent for three years in a row. Harvard Pilgrim Health Care of Wellesley and other Massachusetts insurers have also expressed concerns about imaging costs.

Enter the counterattack from a trade group, the National Electrical Manufacturers Association, and a subgroup of its companies that produce imaging equipment. Robert G. Britain, a vice president for the group, said it has spent $184,000 on the effort including the website medicalimaging.org and print ads in the Washington, D.C., publication Roll Call, which covers Capitol Hill.

Irene Plenefisch, director of payer and external relations at SonoSite Inc., a Bothell, Wash., ultrasound-equipment maker, said the company and others share concerns about rising costs. But she said many of the imaging procedures at issue actually avoid the need for other spending, such as improved mammograms that avoid the need for complicated biopsies. David Rollo, chief medical officer of Philips, in Andover, used a similar example.

But it's easier to blame new imaging spending than other costs that doctors can control, he said. ''As much as anything in medicine, there are political issues surrounding imaging," he said.

Along with Gazelle's study, the trade group cites another study by Massachusetts General radiologists that found the growing use of CAT scans actually lowered hospital costs 22 percent for some patients with facial injuries compared with conventional X-rays. The time required for a facial CAT scan fell from 40 minutes in 1992 to 35 seconds in 2002.

It also notes a study published in the Journal of the American Medical Association in June arguing the growing use of imaging reflected what it called ''defensive medicine" behaviors, or doctors ordering extra checks out of fear they could be sued for missing some conditions.

Ross Kerber can be reached at kerber@globe.com.