By Michael Pearson
If you had to pick one tool that ties together just about every field of modern medicine, imaging technologies would be a good choice. After all these technologies —everything from x-rays to CT scans, are a part of many medical procedures, from routine checkups to sophisticated brain surgeries.
Danny Hughes, a health economist at the Georgia Institute of Technology’s School of Economics, is using data about how often such technologies are used to reveal the ways in which the Covid-19 pandemic has impacted the medical imaging sector, and how it might affect the health of Americans in the years to come.
“Looking at imaging data is the fastest way to get a pulse of what’s happening in any clinical specialty,” said Hughes, director of the Health Economics and Analytics Lab (HEAL). “This pandemic, tragic as it is, also provides an unprecedented opportunity to evaluate the efficacy of some of the screenings that people may put off or skip as a result of Covid-19.”
Exploring Covid-19’s impact
Hughes has worked on three recent papers, all published in the Journal of the American College of Radiology, evaluating how dramatically imaging procedures fell during the height of the pandemic’s initial peak.
One paper shows that the use of diagnostic imaging services at nine community radiology practices across the country fell 52% from February to April, with outpatient imaging seeing even bigger declines — 66%. Mammography and abdominal and pelvic CT scans accounted for the largest share of the drop, the group reported in a paper written by Richard Duszak, Jr., an Emory School of Medicine professor, and co-authored by Hughes, his graduate assistant, Candice Sessa, and four others.
Another paper looked at imaging utilization at a large hospital system in the Northeast, finding a 28.1% drop in imaging volume in the weeks after the outbreak reached the United States as compared to the previous year.
The third paper Hughes co-authored is the first to evaluate the change in volume and type of inpatient imaging procedures due to the pandemic. That study found a 13.6% decline in the use of imaging tools to help treat hospitalized patients at one health center during the pandemic, especially in the first few weeks of the outbreak. It also tracked a notable change in the composition of imaging tests with a fewer proportion of advanced procedures, such as CT scans and MRIs, performed on hospitalized patients relative to X-rays.
HEAL seeks to understand reimbursement & payment policies
Hughes analyzed the data using the statistical and machine learning models HEAL typically uses to understand reimbursement and payment policies, data that can ultimately be of use to policymakers in making decisions about how to structure Medicare policy and make other decisions about health care in the United States.
“Imaging touches every other part of medicine,” Hughes said. “You’re not getting a joint replacement without an image; you’re not getting stroke treatment without an image. The thing about imaging data is you learn about all of the rest of medicine very quickly, and you understand what’s happening with those trends.”
That helps him make sense of complex resource utilization issues that come up frequently in discussions about health care pricing and reform, including discussions about Medicare, Medicaid, the Affordable Care Act, and other issues.
The disruption in imaging services also provides an unprecedented window into the potential impacts of deferred or skipped diagnostic testing on health outcomes. Anecdotal reports indicate that the number of patients seeking care for strokes, cancer, and other health issues has fallen dramatically since the pandemic reached the United States. Health care experts doubt those maladies have gone away, but rather that patients are putting off going to the doctor for fear of getting infected by SARS-CoV-2, the virus that causes Covid-19.
“This gives us a chance to evaluate things you never could in a clinical trial,” Hughes said. “You could never say, ‘Okay, you 30 stroke patients, you’re going to stay home, and you 30, you’re going to come in and get treatment. But with people deferring screening and care because of Covid-19, we will get the chance to test the efficacy of some of those things.”
The work he is doing on Covid-19 could wind up helping inform decisions about diagnostic testing recommendations or may be presented to lawmakers, helping inform decisions about what federal policy interventions the medical sector might need as it works its way through the economic aftershocks of the pandemic.
Already, Hughes said, he is aware of several radiology practices suffering financial difficulty as a result of the pandemic’s widespread economic shocks.
“Is there some dispensation or policy that can come out of existing government programs or other federal support to try and help buffer that shock?” he said. “I’m not sure. I don’t usually get involved in advocating specific policies. But policy stakeholders look to HEAL to provide credible, objective data and I appreciate the opportunity to contribute to our understanding of the pandemic so we can collectively chart a solid course to recovery.”
Hughes’ work is funded by the American College of Radiology and the Neiman Health Policy Institute.
The School of Economics is a unit of the Ivan Allen College of Liberal Arts.