Excessive MRI for Back Pain Relief?

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MRI scan for back pain relief lumbacurveThere’s an interesting article featured in the Pioneer Press on MRI in the treatment for low back pain which questions the possibility of it’s overuse in some states in the US.

During 2009, a high percentage of outpatients with low back pain at Minnesota hospitals underwent a MRI without first trying alternatives that were both cheaper and recommended in expert guidelines. It was the second year in a row that the states hospitals reported such high scores, which would suggest that the medical centres could be carrying out unnecessary MRI’s during back pain treatment.

Across the US, 32% percent of Medicare patients with low-back pain who were treated as hospital outpatients in 2009 had MRIs without first trying the “conservative care” approaches that current guidelines support, according to a report released earlierthis month. But in Minnesota, the rate was 41% according to the annual Hospital Compare survey from the Centers for Medicare and Medicaid Services.

Minnesota has a reputation for being thrifty about using high-tech health care, but it is acquiring a reputation as a spendthrift when it comes to treating low back pain. For the second year in a row, outpatients at Minnesota hospitals were more likely than their peers across the country to have a magnetic resonance imaging exam without first trying recommended, lower-cost back pain therapy treatments such as physiotherapy, according to a new government report.

Hospitals called the new numbers misleading because they are based on old data, cover only a small subset of patients and might be based on a flawed methodology. But the finding seems to fit with other recent concerns from local insurance companies and health quality groups that care costs for back pain relief are too high in this region.

An MRI is a test that uses a powerful magnetic field and a computer to produce detailed pictures from inside the body. Hospital charges for an MRI of the spine vary, but “medium-cost” providers in Minnesota charge $778 to $1,389, according to Medica, a health insurer based in Minnetonka. Medicare pays about $500 per test and spent about $420 million on low-back MRIs nationally in 2009.

“There’s a widespread belief that MRIs in low back pain treatment are overused in the sense that they don’t really add anything beneficial to improving outcomes,” said Dr. Michael Rapp, director of the quality-measurement and health-assessment group at the Centers for Medicare and Medicaid Services. “This is one of our efficiency measures….It’s just sort of a reflex, sometimes – people think, ‘I’ve got back pain, so I should have an MRI.’

While the new report shows scores for hospitals relative to a national average, it does not answer what Dr. Craig Svendsen, the chief medical-quality officer of the St. Paul-based HealthEast system, thinks is the real question: “What’s the right rate?”

“I have a lot of questions in trying to understand what (the scores) mean,” Svendsen said. “MRI scans themselves are not very harmful. They are harmful to the degree that they may lead me into a false understanding” of what’s causing the back pain and whether it can be fixed with surgery.