Low-Value Diagnostic Imaging in Children with Medicaid.

Area of Science:

• Pediatric healthcare utilization
• Health services research
• Medical imaging economics

Background:

• Low-value imaging contributes to rising healthcare costs.
• Understanding patterns of low-value imaging in pediatric populations is crucial for cost containment.
• Pediatric Medicaid beneficiaries represent a vulnerable population where resource optimization is essential.

Purpose of the Study:

• To quantify the incidence and healthcare settings of low-value imaging among children insured by Medicaid.
• To estimate the financial expenditures linked to these low-value imaging services.

Main Methods:

• A retrospective longitudinal cohort study analyzed data from Pennsylvania Medicaid beneficiaries under 18 years old from 2014 to 2016.
• Low-value imaging rates were assessed for five specific conditions using diagnosis codes.
• Healthcare settings and paid amounts were examined to determine costs.

Main Results:

• 5.8% of 645,767 encounters for the studied conditions involved low-value imaging.
• High rates were observed for radiographs in bronchiolitis (246.0/1000), head CT for minor head trauma (174.0/1000), and neuroimaging for headache (155.0/1000).
• Low-value imaging occurred predominantly in non-pediatric emergency departments and outpatient settings, costing Medicaid over $7 million.

Conclusions:

• Over 1 in 20 encounters for the studied conditions involved low-value imaging, primarily in emergency departments and outpatient settings.
• Non-Hispanic White children and those in rural areas showed higher rates of low-value imaging.
• Targeted interventions are necessary to reduce the performance of these low-value imaging services in pediatric Medicaid populations.