Applying evidence-based imaging to policy: the Washington State experience.

In response to escalating medical costs and a lack of evidence supporting some medical procedures, the state of Washington initiated a new program to use evidence-based medicine to determine if medical technologies should be covered for reimbursement by state agencies. The Washington State Health Technology Assessment Program was formed to commission evidence reports on selected technologies and to determine reimbursement on the basis of evidence of effectiveness, safety, and cost-effectiveness. To date, the program has reviewed the imaging technologies of upright magnetic resonance imaging, computed tomographic colonography, and lumbar discography and has not found sufficient evidence to support reimbursement. This report details the structure of the program, the reasons for the committee's decisions, and the implications for radiology. Under the Washington model, stronger evidence for the effectiveness, safety, and cost-effectiveness of imaging will be required for the dissemination of new technologies and for reimbursement for some existing imaging approaches.