Just ask: a proposal to hone the indications for sophisticated radiology examinations

AIthough MRI and CT have revolutionized healthcare, the growth in their utilization comes with a commensurate and unsustainable growth in spending. The cost of sophisticated radiology tests goes beyond the cost of the technology itself because the tests can be so sensitive, they can lead to excessive treatments when incidental findings are not labeled as such. Thus to improve utilization for its own sake, but more importantly to limit spending on unnecessary treatments, we propose that requests for MRI and CT studies must be accompanied by a clinical question, and all reports offering interpretations must include a direct answer. This approach should increase the effective specificity of the tests that are performed, and in turn decrease provocation for unnecessary treatments. This question/answer policy can be implemented by new Medicare payment guidelines that echo the Medicare reimbursement rules for standard medical consultations.