Washington State

House of Representatives

Office of Program Research

BILL

ANALYSIS

Health Care & Wellness Committee

HB 2105

This analysis was prepared by non-partisan legislative staff for the use of legislative members in their deliberations. This analysis is not a part of the legislation nor does it constitute a statement of legislative intent.

Background:

Diagnostic imaging allows doctors to "see" inside the body by obtaining pictures of bones, organs, muscles, tendons, nerves and cartilage. Diagnostic imaging includes Magnetic Resonance Imaging (MRI), Computed Tomography (CT), and Positron Emission Tomography (PET), as well as ultrasound, nuclear medicine, picture archival communication systems, digital mammography, and molecular imaging. These technologies enable physicians to diagnose diseases at earlier stages while avoiding more invasive and costly diagnostic procedures.

While a significant technological advance, diagnostic imaging is also the fastest-growing medical expenditure in the United States, with an annual 9% growth rate – more than twice that of general medical expenditures (4.1%) according to the American College of Radiology Web site (May 2004). There are several strategies to help control the increasing costs of diagnostic imaging, including:

Utilization Management: Some health insurers are using radiology benefit management firms to attempt to control diagnostic imaging costs;

Physician Self-Referral Restrictions: Federal Stark II regulations generally prohibit physicians from referring Medicare patients to entities with which the physician or immediate family member has a financial interest. Some states have similar statutes that also regulate referral of private-pay patients;

Evidence-Based Practice Guidelines: One strategy is to develop and disseminate nationally recognized, evidence-based practice guidelines and to educate referring physicians about the proper use of diagnostic imaging. The American College of Radiology has developed appropriateness criteria for a number of common presentations and developed recommendations for tests that have been found to be particularly effective, and tests that are not as effective;

Patient Education: Patient education campaigns, similar to those addressing inappropriate antibiotic use, may be effective in discouraging patients from seeking unnecessary tests; and

Electronic Medical Records System: Studies have found that at least 10% of diagnostic tests are retests because prior results were unavailable to the treating physician at the point of service. Retesting could be reduced with electronic records and better communication and process management among the relevant parties.

Summary of Bill:

The Speaker of the House of Representatives and the Majority Leader of the Senate will convene a work group to analyze and identify nationally accepted best practice guidelines or protocols applicable to advanced diagnostic imaging services and any decision and support tools available to implement the guidelines or protocols.

The Health Care Authority will implement nationally accepted best practice guidelines or protocols applicable to advanced diagnostic imaging services for all state-purchased health care programs by January 1, 2010.