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Scans, Surgeries Go Up After Docs Acquire MRI

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After primary-care physicians and orthopedic surgeons acquire in-office MRI machines, they start ordering more MRIs for patients complaining of low back pain. And more of the orthopedic surgeons’ low-back-pain patients begin undergoing surgery.

Those are the not terribly surprising findings of a study published online last week in the journal Health Services Research.

The study notes that other studies have shown similar results and adds:

Increasing use of imaging has also been associated with the potential for ‘treatment cascades,’ in which the use of imaging leads to the use of subsequent procedures that are of low value to the patient and, but for receipt of the imaging procedure, would never have been done.

The study notes that guidelines advise a conservative approach to low back pain because symptoms often improve without treatment and the correlation between imaging findings and clinical symptoms is weak.

Two Stanford University School of Medicine researchers carried out the study: Jacqueline Baras Shreibati, MD, of the department of medicine and Laurence C. Baker, PhD, of the department of health research and policy.

They reviewed scan rates for Medicare patients of 1,033 primary care physicians and 1,271 orthopedists both before and after the doctors acquired MRI machines, covering the period of 1999 through 2005.

Lo and behold, the researchers discovered that the rate of MRI scans increased by 32 percent for patients of primary care doctors and 13 percent for patients of orthopedists. And the study found that among orthopedists’ patients, the probability of undergoing surgery within six months of the MRI exam increased by 34 percent.

The authors interpret this data thus: “Orthopedists and primary care physicians who begin to bill for the performance of MRI procedures, rather than referring patients outside of their practice for MRI, appear to change their practice patterns such that they use more MRI for their patients with low back pain. These increases in MRI use appear to lead to increases in low back surgery receipt among patients of orthopedic surgeons, but not of primary care physicians.”

The increases in MRI use also led to increased costs, the study found, but only among patients of orthopedists. Such patients paid an average of $4,161 more per year after their orthopedists acquired an MRI machine.

“One important implication of this finding is that the costs of doing these incremental MRIs was much higher than just the cost of the MRI itself (roughly $500),” the study says, “and it could appropriately be taken to include the costs of the additional procedures done as a result of the MRI.”

The authors do note that some or all of these extra scans and surgeries may have led to improved patient outcomes.

Undoubtedly, they led to improved financial outcomes for the doctors.

Related seminar: Musculoskeletal MRI


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