A medical-testing lesson from Minnesota: Less can be more

  • Article by: JEREMY OLSON , Star Tribune
  • Updated: January 6, 2014 - 8:29 PM

The state’s approach to cutting unneeded medical scans could be a model for federal Medicare savings.

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More than 80 percent of imaging scans in Minnesota are now ordered only after doctors consult a standard set of guidelines to make sure the scans are recommended based on their patients’ conditions and medical histories.

Photo: Richard Tsong-Taatarii, Star Tribune

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A novel strategy that has saved Minnesota millions of dollars in unnecessary medical-imaging scans — and probably prevented dozens of patient deaths — might soon go national.

Leaders from Minnesota’s medical and insurance communities met Monday morning to celebrate the project — which has leveled off the skyrocketing growth of MRI and CT scans for back pain, headaches and other problems — and to promote legislation by Rep. Erik Paulsen that would bring it to bear on the federal government’s vast Medicare program.

Minnesota’s “decision support” strategy, enacted in 2006, created a single set of standards for doctors to follow in deciding when patients need the costly scans. It also created a green-yellow-red coding system to show patients when scans were recommended and when they weren’t. The use of such scans, which had been growing at a 7 percent annual clip, grew just 1 percent from 2007 to 2012.

“It happened immediately,” said Cally Vinz, a vice president of health care improvement for the Institute for Clinical Systems Improvement, or ICSI.

The Bloomington-based collaborative advises Minnesota health plans, physicians and other providers on ideal medical policies and practices. One recent ICSI project aimed at improving efficiencies was the so-called DIAMOND program to assist primary care clinics in treating patients with depression.

ICSI estimates that the medical-imaging protocol has prevented $234 million in questionable or unnecessary scans, and 96 cancer-related deaths that would have been expected due to the radiation exposure that comes with CT scans, had use of the scans continued growing at previous rates.

And although patients sometimes want more and better medical tests, ICSI officials said patients are often glad to receive the “good news” that they don’t need an imaging scan based on their condition, or that they should wait to see if other symptoms emerge first. Vinz recalled one woman whose doctor showed her that a proposed scan in her case would be in the “red” category, suggesting it wouldn’t be worth the risk and the cost.

“Well, I don’t want a red!” the woman exclaimed.

Paulsen, a Republican who represents Minnesota’s Third Congressional District and has authored several health-reform measures, said he hopes the evidence, combined with a favorable political climate in Congress, make the timing right for the Minnesota approach to be replicated in Medicare, the government health care program for the elderly and disabled. Medicare’s outlays have grown rapidly in the past two decades, reaching nearly $600 billion last year, making it a regular target in Congressional budget discussions.

Lawmakers are trying to reform the so-called sustainable growth rate formula, which determines how much Medicare pays physicians for services, and Paulsen said he believes his bill could become part of that effort.

“If you let this slip away,” he told the group Monday, “it’s going to be a lot more difficult to solve later.”

Vinz said she has talked with insurance and health care leaders in other states about this approach, in part because alternatives such as prior notification — which requires insurers to sign off on scans before they are performed — create adversarial relationships between patients, doctors and insurers. Minnesota health plans had adopted prior-notice rules in 2006, but phased them out due to the success with the decision-support tool.

But officials in other states often view Minnesota as “quite peculiar” because of its small, cooperative community of insurers and physician groups, and don’t believe its innovations can be repeated elsewhere, said Dr. Pat Courneya, medical director of HealthPartners, the Bloomington-based health plan.

Getting this type of approach to succeed in Medicare, on the other hand, would cause it to spread to other states, he said.

More than 80 percent of imaging scans in Minnesota are now ordered only after doctors seek out decision-support guidance to make sure they are recommended based on their patients’ conditions and medical histories.

Courneya said the initial guidelines were based on the clinical expertise and recommendations of Minnesota doctors. They have since been revised as studies refine when imaging scans should be used. Research, for example, has identified the types of patients who are suitable for scans to screen for breast or lung cancers.

Courneya said he hopes the “decision support” tool can grow to include genetic testing and other medical tests that doctors and patients don’t know for certain when to use.

Jeremy Olson • 612-673-7744

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