Interesting Piece in NY Times on the Use and Interpretation of MRIs

[MylesBAstor]

http://www.nytimes.com/2011/10/29/health/mris-often-overused-often-mislead-doctors-warn.html?pagewanted=1&_r=2

 

[Supersnake]

Title of article is: "Sports Medicine Said to Overuse M.R.I.’s"

 

[MylesBAstor]

Title of article is: "Sports Medicine Said to Overuse M.R.I.’s"

Yes it is. And your point is?

 

[Supersnake]

Point was that the title was missing.

 

[MylesBAstor]

Point was that the title was missing.

Guess I didn't think it was necessary. That fact could be gleaned from reading the piece--which by the way, I don't totally agree with the conclusions. Seen too many cases where MRIs also miss things.

Point really is that as we age, we accumulate many types of injury. For instance, if you did MRIs of people's shoulders, would find many cases of slap tears of the labrum. Thing is and we don't understand why, some people are symptomatic and others are pain free. Same goes for back issues. Docs (and many PTs) are good at fixing things but often miss the functional aspects. People do their PT, are pain free, joint has normal range of motion, MMT checks out ok, yet the person is back in PT in a couple of months again. So what is being missed is the neuromuscular control of movements patterns and posture that are altered with injury. For instance, a "strong" muscle as Janda showed can still be inhibited; that is why MMT is often misleading.

 

[jazdoc]

A couple of thoughts from a practicing radiologist...

First, no test and no physician is perfect. As I am fond of telling my co-workers "If I was perfect, I wouldn't be working here!"

Secondly, the article demonstrates how trends of self-referral and consumer oriented medicine can combine to raise costs without necessarily improving outcomes. My emergency room colleagues are confronted on daily basis with patients whose chief complaint is "I want an MRI". Not "my leg hurts" but "I want an MRI". As to self-referral, we've had good data since the mid-80's that when non-radiologist physicians own expensive imaging equipment utilization goes up...dramatically; on the order of 4-10x! Indeed, medical imaging has become the fasting growing component of Medicare/Medicaid and yet referrals to radiologists are only rising commensurate to population growth and the aging population. The difference is from self-referral which results from a failure of sound regulation due to a loophole in the Stark Law. By contrast, there is a reason physicians are not allowed to own a pharmacy....

 

[MylesBAstor]

A couple of thoughts from a practicing radiologist...

First, no test and no physician is perfect. As I am fond of telling my co-workers "If I was perfect, I wouldn't be working here!"

Secondly, the article demonstrates how trends of self-referral and consumer oriented medicine can combine to raise costs without necessarily improving outcomes. My emergency room colleagues are confronted on daily basis with patients whose chief complaint is "I want an MRI". Not "my leg hurts" but "I want an MRI". As to self-referral, we've had good data since the mid-80's that when non-radiologist physicians own expensive imaging equipment utilization goes up...dramatically; on the order of 4-10x! Indeed, medical imaging has become the fasting growing component of Medicare/Medicaid and yet referrals to radiologists are only rising commensurate to population growth and the aging population. The difference is from self-referral which results from a failure of sound regulation due to a loophole in the Stark Law. By contrast, there is a reason physicians are not allowed to own a pharmacy....

Great comments!

But aren't the number of machines regulated by the state?

You are right about them being lucrative sources of income

 

[Steve Williams]

IMO there isn't an orthopedist whose practice lacks an MRI

 

[jazdoc]

But aren't the number of machines regulated by the state?

Not really; and it varies from state to state. The federal Stark regulations regarding the 'in office ancillary exception' are the regulatory standard. Some states have responded with additional regulatory mandates with variable to little success in reducing self-referral.

 

[MylesBAstor]

Not really; and it varies from state to state. The federal Stark regulations regarding the 'in office ancillary exception' are the regulatory standard. Some states have responded with additional regulatory mandates with variable to little success in reducing self-referral.

That's interesting. I remember when the machines were first being introduced and there were two hospitals across the street from each in the city. The health commissioner wouldn't allow both to have a machine. Guess it's changed or as you mentioned varies from state to state.

 

[jazdoc]

Myles,

Here is a link to a recent illustrative article about imaging self referral and cardiology: http://www.medscape.com/viewarticle/753289?src=mp&spon=35

Key quotes include:

The cumulative incidence of nuclear stress testing was 12.6% among physicians who billed for the technical and professional fees; 8.8% among physicians who billed only for the professional fee; and only 5.0% among physicians who only referred patients for testing and did not collect a fee for the test. For stress echocardiography, the cumulative incidence of testing was 2.8% for doctors who received both fees, 1.4% for those who received only the professional fee, and 0.4% for those who received neither.

Centers for Medicare & Medicaid Services is already trying to prevent overuse of cardiac stress imaging billed to Medicare by reducing reimbursement of cardiac stress imaging. While this has slowed the growth of this kind of testing, the reduction in payments also appears to have driven many cardiologists to leave single-specialty groups to join larger multispecialty and hospital-based practices. This may lead to an increase in cost, the editorialists argue, because physicians working for the hospital may be compelled to meet hospital-imposed productivity targets by referring more patients for imaging at outpatient facilities owned by hospitals, "where care is more expensive and often less efficient."

 

[MylesBAstor]

Myles,

Here is a link to a recent illustrative article about imaging self referral and cardiology: http://www.medscape.com/viewarticle/753289?src=mp&spon=35

Key quotes include:

Thanks!