Purpose or Case Report: To evaluate patterns of advanced imaging utilization and associated costs over an 8-year period in one of the largest pediatric Accountable Care Organizations (ACO) in the US covering over 300,000 children.
Methods & Materials: Advanced imaging claims data for each year from 2010-2017 from the ACO (Partner for Kids) were reviewed. MRI, CT, and US utilization trends from all emergency department (ED) and outpatient (OP) encounters and associated costs were analyzed. Utilization rate (UR) was defined as the number of procedures per 100 enrolled children per calendar year. Cost per procedure was calculated, and yearly utilization and expenditure trends analyzed using Pearson’s correlation.
Results: Over the eight-year period, a total of 202,345 advanced imaging studies were performed. Average overall UR was 6.8 advanced imaging studies per 100 children per year (1.2 for MRI, 2.7 for CT, and 3.0 for US). The total cost of advanced imaging studies was $6,659,272 per year on average ($2.4 M for MRI, $2.7 M for CT, and $1.4 M for US). In the ED, between 2010 and 2017, UR of US increased from 0.5 to 1.0 (r = 0.99), UR of CT increased from 1.4 to 1.9 (r = 0.48) and UR of MRI in the ED changed from 0.03 to 0.04 (r=0.7). In the OP setting, between 2010 and 2017, UR of US also increased from 2.0 to 2.4 (r=0.94), UR of CT decreased slightly from 0.8 to 0.7 (r=-0.71), and UR of MRI remained similar from 1.12 to 1.13 (r = -0.24). Total advanced imaging UR in the ED showed a steady increase from 1.9 to 2.9 (r = 0.82). The overall advanced imaging use in the OP setting showed a smaller overall rise from an UR of 3.9 to 4.3 (r = 0.57). The cost per procedure did not demonstrate any significant increase from 2010 until 2017 with less than 1.7 % change each year, except for ED US (2.8% yearly growth).
Conclusions: This is the first study of imaging trends and associated costs in a large pediatric ACO. The 8 year analysis demonstrated an increase in overall advanced imaging utilization, which was more pronounced in the ED setting. By analyzing imaging utilization trends sorted by patient care setting, modality, and cost, it improves the global understanding of imaging to cover a diverse pediatric population. It also creates the foundation for studying value of imaging in the ACO in discrete patient care pathways, which in turn, will allow targeted interventions to improve quality, safety, and effectiveness of care.