Partnering for better outcomes - Quality, accessible medical imaging

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Since the very first x-rays were taken in the 1890s, medical imaging has been a boon to the sick and injured worldwide. And as the technology and expertise has improved  – from viewing bones, to soft tissue and now to real-time physiological processes – the benefits have only increased. Virtually every aspect of modern diagnosis and treatment now involves medical imaging in some way, writes Dr Chris Wriedt.
However, we are still not getting the best from this amazing technology. To ensure the benefits of medical imaging are enjoyed by the largest number of people possible, and to ensure taxpayers receive the best value for money possible, we need to look closely at the policy settings and work with government and consumers to enhance frontline services.
More than any other area of medicine, medical imaging has undergone an enormous transformation in recent decades as older technologies evolve and new modalities such as Computed Tomography (CT) and Magnetic Resonance Imaging (MRI) emerge. Last year, the private medical imaging sector delivered the vast majority of the 21.3 million Medicare-eligible services – almost one imaging service for every Australian – through clinics based in public and private hospitals as well as in community settings. These services range from x-rays for suspected fractures to intricate interventional procedures guided by MRI, CT or ultrasound which replace the need for lengthy hospitalisation and invasive surgery.
The steady growth and evolution of medical imaging has cemented its position at the centre of almost all modern medical practice. In fact, imaging has become so central to modern medicine that many see it as routine.
That is far from the truth.
It is important to recognise that each medical imaging service is a consultation with a medical specialist – a radiologist - who has many years of specialised training. Together with state-of-the-art equipment and the support of skilled allied health professionals, each consultation culminates in a specialist report that provides a diagnosis, details progression of an existing condition, or guides the formulation of treatment for a known condition.
And as technology continues to advance and our knowledge continues to grow, medical imaging – and the experts who provide it - will continue to guide innovative solutions to improve patient outcomes, reduce the burden of disease on society and lower health expenditure.
However, in order to harness new innovations and provide the best possible care to our patients, we need policy makers and funders to acknowledge medical imaging’s unique and evolving position in medicine and keep up with the rapid change in the sector.
ADIA, as the peak body representing medical imaging practices, actively promotes quality practice standards, so that patients and their doctors can have certainty of quality, access and delivery of medical imaging services. True access, of course, means affordable access so we are committed to ensuring that appropriate funding is available to ensure all patients can receive the imaging service which is recognised as clinical best practice.
In an effort to improve health outcomes while recognising the difficult fiscal environment, ADIA is continuing to seek government support for initiatives that are vital to patient safety and outcomes, and demonstrate prudent use of resources while improving the sector’s sustainability. The policy and funding decisions of the past 20 years locked the sector into a vicious cycle led by significant funding decreases, in part due to the fact that there has been no indexation on Medicare benefits for medical imaging since 1998.
Last year, the average cost of providing a medical imaging service in Australia was $162 while the average payment was $148 – clearly this is not sustainable. The effects of this funding squeeze have been wide-ranging, including a sharp rise in out-of-pocket costs borne by patients which now average $88 per service, declining access to comprehensive practices in all areas across Australia, and compromises on quality as practices seek to make ends meet. All these are worrying trends that need to be addressed as a matter of urgency.
It is vital that we seek to address these issues and secure the future of the sector so there is sufficient ongoing capacity and capability to provide a quality service to each of our patients, at an affordable price and in a convenient location, and the community is able to take advantage of the future advances in medical imaging that will further reduce healthcare costs and improve productivity. ADIA seeks to do this through our current priorities, detailed in a recent 2014-15 Federal Budget submission (available at www.adia.asn.au):

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  Ultrasound services: With almost 8 million services delivered in the last financial year, ultrasound examinations comprise some 37% of Medicare-eligible services.But, as the required equipment becomes cheaper and easier to use, ultrasound is also being used by non-imaging medical and health professionals as a tool to provide information as part of their clinical examination. This expanded use of ultrasound in different areas of medical practice has blurred the lines and introduced confusion for patients and providers. As a matter of urgency, ADIA is advocating for the introduction of enforceable quality criteria for all Medicare-eligible diagnostic ultrasound services. By defining more clearly what a diagnostic ultrasound examination entails, as well as setting minimum qualification standards for staff delivering the services and minimum equipment specifications, patients would be assured that all diagnostic ultrasound services are being delivered to a high standard and are an effective use of resources.

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  Computed Tomography (CT) services: There is no doubt the emergence of CT has provided invaluable new data to medical practitioners, assisting in the earlier detection and treatment of diseases such as colon cancer and leading to better health outcomes for patients. Around 2.5 million CT services were provided in 2012-13, 91% of those outside of hospital settings. However, like ultrasound, enforceable quality criteria for Medicare-eligible CT services need to be implemented. In addition to setting minimum qualifications for staff and minimum standards for equipment, we need to carefully consider the risks involved in this modality due to radiation exposure. ADIA is working with government and other stakeholders to define the role of the radiologist in the provision of CT services, to ensure that patients and staff have ready access to a medical specialist who can advise on dose optimisation, offer substitute imaging services where the radiation risk is considered to outweigh the benefit, and to ensure the safety of the patient should they have  an adverse reaction to the contrast agents used as part of the service.


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  Updating equipment upgrade provisions to support quality investment: Medicare reduces the benefit payable when imaging equipment reaches a certain age. However, this regulation does not adequately acknowledge that equipment manufacturers offer the option of software and other significant upgrades for CT and Angiography equipment. Nor do they adequately provide for MRI upgrade pathways that bring the equipment in line with current day technologies economically and without the need to replace expensive units.


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  Improving care and reducing duplication of services by providing access to imaging records: The sector has developed a roadmap detailing the work required to introduce systemised access to digital images. By enabling all clinicians to have instant digital access to a patient’s imaging history, we would reduce the number of repeat imaging services required and improve our patient care by being able to analyse disease progression or monitor the effectiveness of treatment over time. This opportunity builds on existing resources, introducing full interoperability so that regardless of where the imaging service was provided, a clinician will be able to view the images in a format that enables image comparison.

With government and the industry working together and supported by consumers, these priorities can be significantly progressed in 2014-15, so patients and the broader community can be assured that medical imaging is not only contributing to better health outcomes but is being properly configured to contain rising health costs.
As well as our work with government, ADIA is working with many other groups to strengthen and streamline medical imaging services.
To ensure that our members - the clinics which provide medical imaging services - understand and are responsive to changing patient expectations we are working closely with referrers, and more recently, with consumer advocacy groups such as the Australian Diabetes Council and Osteoporosis Australia. Through this ADIA aims to gain a thorough understanding of concerns relating to medical imaging, and keep our members connected with the expectations of patients, as well as providing clinical input where required. Additionally, ADIA is seeking to collaborate further with the broader medical imaging sector to develop a vision and set priorities for the future to ensure that Australians are able to access the most appropriate diagnostic imaging service, at an affordable cost and from a provider that places quality outcomes and patient safety as its highest priorities.
Medical imaging has enormous potential to further transform medicine in the coming decades. A combination of technological advances and research will provide possibilities for reducing disease burden, improving treatment and reducing the cost of healthcare. ADIA is excited about what the future holds and looks forward to partnering with patients, referrers and the broader community as we strive to meet growing expectations and enhance all outcomes.

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“More than any other area of medicine, medical imaging has undergone an enormous transformation in recent decades as older technologies evolve and new modalities such as Computed Tomography (CT) and Magnetic Resonance Imaging (MRI) emerge.”

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Dr Chris Wriedt
President of the Australian Diagnostic Imaging Association
ADIA represents medical imaging practices throughout Australia, both in the community and in hospitals, and promotes ongoing development of quality practice standards so doctors and their patients can have certainty of quality, access and delivery of medical imaging services.
Visit our website www.adia.asn.au