• Do you really need that MRI scan?

    Let me begin by pointing out that the findings I’m going to be talking about here aren’t from a peer-reviewed publication; they are from a presentation at a meeting. Such findings have limitations. However, I couldn’t let these go without commenting.

    This week, at the annual meeting of the Radiological Society of North America, a study was presented that looked at whether the ways in which orthopedic surgeons referred patients for MRI scans differed if they had a financial stake in the machines:

    More and more physicians are investing in their own imaging equipment. But when a doctor stands to make money on each MRI he or she orders, it doesn’t take a brain surgeon to figure out that they might be inclined to order too many scans.

    So did they? It sure seems so. Doctors who did not have a financial stake in the MRI machines had about 23% of their scans come back negative. Doctors who did have a financial stake in the MRI machines, on the other hand, had about 42% of their scans come back negative. It seems like docs with a financial stake in the machines might have had a lower threshold for ordering a scan. Moreover, they seemed to order scans on younger patients. The average age of a patient sent for a scan by docs with a financial stake was 50, while it was 57 for docs with no financial interest.

    Now some caveats. This doesn’t mean that the docs with a financial stake are corrupt. It also doesn’t mean that there might not be some legitimate reason for the difference. Perhaps the patients of docs who have financial stakes are trickier to examine. However, since the severity of problems seen in the two groups of positive patients were similar, that isn’t too likely. Also, as I said at the start of the piece, this is only a meeting presentation. Te study may be flawed in ways I can’t assess right now. I look forward to reading the full paper when it is hopefully published.

    But none of these things should wipe away the issues this study uncovers. After all:

    Medical imaging overall cost Medicare some $14.1 billion in 2006—about twice as much as in 2000, according to a 2008 U.S. Government Accountability Office report. About $3.9 billion of that was from physicians who referred patients for imaging in their own offices, according to a JulyJournal of the American College of Radiology paper, co-authored by Ramsey Kilani, also of Duke, who worked on the new study as well.

    There’s plenty of fat to be trimmed in health care. This is as good a place as any to start.

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    • This is very insightful research. I had a general practice doctor tell me he was approached by an MRI salesman who proposed placing a machine in the Dr’s office for very cheap and then the two could “split the profits” of running extra tests. The physician politely declined, but you can see why it would be appealing to do that. Not only can you cover liability by ordering extra tests, but you can be reimbursed for it too!

    • Why should this be surprising? Doctors are people, too. Now, if the cost of the MRI were shared by the patient, say at 40%, maybe the results would have been somewhat different?