Q&A: EviCore’s Chief of Radiology on the Need for Evidence-Based Imaging

We sat down with Dr. Sheldon L. Scheinert, MD, FACG, Associate Chief Medical Officer of Diagnostic Solutions for EviCore. Dr. Sheldon L. Scheinert's job is to make sure patients get imaging tests like MRIs and CTs that are aligned with the latest medical science. 

Why is EviCore’s Radiology solution important?

That’s a whole lot of tests that aren’t likely to help find the right diagnosis or treatment for the patient.[1] Unfortunately, study after study has found that a significant number of imaging tests like CTs and MRIs don’t meet current evidence-based medical guidelines, meaning they’re not likely to provide value to the patient. For example, one study found that 60% of lower back MRIs and over 30% of MRIs for shoulder pain and knee pain were inappropriate.

What’s the big deal if a person gets an extra imaging test?

[2] Performing imaging tests that may not be needed can negatively impact patients in several ways. First, they can lead to false positives that may cascade a bunch of tests and treatments that don’t help patients – and may even be harmful. For example, nearly 70% of doctors say unnecessary cascades of care have caused their patients psychological harm; 16% say they’ve caused patients physical harm; and nearly 60% say they’ve financially burdened their patients.

Inappropriate tests can also expose patients to unnecessary radiation, which can raise the risks for certain cancer types over time. Radiologists consistently work to minimize radiation exposure to reduce these risks for patients. When entire imaging sessions are unnecessary, the amount of avoidable radiation exposure is even greater.

Last but certainly not least, inappropriate tests can lead to higher out-of-pocket costs. For example, That’s a lot of money for a patient to have to pay if a test isn’t actually going to do them any good. These inappropriate tests also add unnecessary costs to the entire healthcare system, which drives up premiums for everyone.[3] Average copays for advanced imaging are $319 and $630 for in-network and out-of-network, respectively.

Doesn’t the doctor know what care is needed for their patient?

Medical knowledge is exploding so fast that it’s impossible for providers to keep up with all the new information. In 1950, it took 50 years to double medical knowledge. In 2010, it took 3.5 years. In 2020, it was estimated to be 73 days.[4] 

In an attempt to address this challenge, the American Board of Internal Medicine Foundation created an initiative called Choosing Wisely[5] in 2012, which tries to help avoid unnecessary tests, treatments, and procedures through educational efforts. Unfortunately, Choosing Wisely has not meaningfully reduced the number of low-value health services.

That’s where EviCore comes in. Our evidence-based clinical guidelines are used to help ensure that requests are in line with current science and medical best practices, which helps to protect patients from the unavoidable knowledge gaps that creep into the practices of even the most talented and knowledgeable physicians.

How does EviCore make decisions that align with medical best practices?

We use our evidence-based guidelines to help determine the appropriateness of a requested imaging test or, in many cases, whether there’s an alternative that would better fit the patient’s needs.

EviCore’s guidelines are based on information from numerous medical societies like the American College of Radiology, as well as recently published, peer-reviewed medical studies. The guidelines are created by physicians who are appropriately specialized, and they’re reviewed by external experts. Our guidelines are updated at least twice a year and are available to anyone by visiting EviCore’s website.

Who makes decisions at EviCore? Are they doctors?

Only a physician can make the determination that a request does not meet the evidence-based guidelines. Yes! EviCore has a team of more than 450 board-certified physicians, as well as other experts like physical therapists, and over 1,000 nurses with experience across multiple specialties. Their job is to help ensure better outcomes for patients.

You can learn more about EviCore’s Radiology solution on our website.

[1], Volume 31, Issue 9, November 2019, Pages 691–697, https://doi.org/10.1093/intqhc/mzy248International Journal for Quality in Health Care S Flaherty, E Zepeda, K Mortele, G Young. Magnitude and financial implications of inappropriate diagnostic imaging for three common clinical conditions.

[2] 2019;2(10):e1913325. doi:10.1001/jamanetworkopen.2019.13325JAMA Netw Open. Ganguli I, Simpkin AL, Lupo C, et al. Cascades of Care After Incidental Findings in a US National Survey of Physicians. 

[3] 2018 Apr;15(4):607-614.e1. doi: 10.1016/j.jacr.2017.12.010. Epub 2018 Feb 22. PMID: 29477290.J Am Coll Radiol.Rosenkrantz AB, Sadigh G, Carlos RC, Silva E 3rd, Duszak R Jr. Out-of-Pocket Costs for Advanced Imaging Across the US Private Insurance Marketplace.

[4]. 2011;122:48-58.Trans Am Clin Climatol Assoc Densen P. Challenges and opportunities facing medical education. 

[5] Cliff BQ, Avanceña ALV, Hirth RA, Lee SD. The Impact of Choosing Wisely Interventions on Low-Value Medical Services: A Systematic Review. Milbank Q. 2021 Dec;99(4):1024-1058. doi: 10.1111/1468-0009.12531. Epub 2021 Aug 17. PMID: 34402553; PMCID: PMC8718584.