The Pioneer Press ran a great piece over the weekend by reporter Christopher Snowbeck on new Medicare data that suggests Minnesota hospitals are performing too many unnecessary — and expensive — magnetic resonance imaging (MRI) diagnostic tests on patients complaining of low-back pain.
Despite professional guidelines advising doctors to first recommend exercise, physical therapy and injections for most of these patients, outpatients at Minnesota hospitals are more likely to undergo a more expensive magnetic resonance imaging exam. … [A]bout 40 percent of outpatients with low-back pain at hospitals here in 2008 had an MRI without first trying recommended treatments, such as physical therapy. The statewide average was greater than the national average of 33 percent.
These statistics represent a considerable amount of wasted health-care money. Low back pain is one of the most common reasons for doctor visits. According to the National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS), in any three-month period, a quarter of American adults experience at least one day of back pain.
Back pain becomes more prevalent with age, a factor that makes it a big issue for Medicare. As Snowbeck reports, Medicare spent about $420 million on low-back MRIs (about $500 each) in 2009.
Yet, as the Mayo Clinic website notes, “[d]iagnostic tests aren’t usually necessary to confirm the cause of your back pain.” Most back pain goes away on its own after a few days or weeks. The first line of recommended treatment, therefore, is over-the-counter pain medication, heat, ice, and, in some cases, physical therapy.
Questioning the data
Minnesota hospital officials are “befuddled” by the results of the Medicare MRI data — and, thus, are questioning the data itself, Snowbeck reports. Yet, the same data source (the federal government’s Hospital Compare website) shows Minnesota hospitals are doing well when it comes to their use of computed tomography (CT) scans — a diagnostic test whose overuse has been identified as not only causing unnecessary expenses but as posing serious health risks.
The hospitals don’t seem to be expressing any befuddlement at those good results from the data.
The story includes … excuses from local providers along the lines of “the data are outdated … we’ve changed … we’re better now … that can’t be right … it’s not us!” When have you ever seen a story on health care data that didn’t have these predictable reactions? It reminds me of The Tobacco Institute continually rejecting any new finding that showed new harms from smoking. When you don’t like the data, damn the data. For most of the history of medicine we had no outcomes data to show patterns of practice or what happens to people over time. Now that we’re starting to collect some such data, vested interests find that information is a menacing thing.
You can read Snowbeck’s article online here. It includes a chart that compares the MRI rates of various Minnesota hospitals.