Over 250 participants, predominately spine specialists, engaged in a recent content-rich webinar (“Beyond Gravity “) hosted by Becker Hospital Review.
Focus was on experiences and outcomes in leveraging weight-bearing MRI technology by way of an engaging session between James J. Lynch MD, FACS, FAANS (Board-Certified Spinal Neurosurgeon, founder/ CEO SpineNevada) and Douglas K. Smith, MD CPHIMS, CHCIO, CHPS (Board-Certified Spinal
Teleradiologist, Clinical Informatist, founder / CEO Salubrio MRI).
Animated spine-focused videos, co-created by Dr. Lynch and Dr. Smith, helped demonstrate their experiences and impact of this technology on several aspects in the Spinal Circle of Care - and their practices. (see below for replay and video links).
**CME Update** - Webinar content has been approved for CME credit (1), Category A. Registered attendees will receive a separate communication from Esaote North America with CME credit license number verification, within the next 10 business days.
Overcoming Barriers
They discussed a common challenge in effectively diagnosing and offering causal evidence of upright spine stress. Although the spine functionally compresses in the upright weight-bearing position to reveal ultimate injury and/or stress-based symptoms, the most commonly used MRIs are conventional – with patient
exams limited to the supine position at which a patient’s pain is predominantly relieved.
Dr. Smith stated “There is nothing worse than a high resolution, falsely negative MRI examination that fails to demonstrate an abnormality seen only during weight-bearing. My patients have broken into tears after weight-bearing images demonstrated the etiology of pain after years of falsely negative supine MRI
examinations”.
They questioned the conventional MRI approach, given symptomatic diagnostics:
“Why lay down for MRIs when spine pain peaks (stresses) standing up?”
They theorized there may be an alternative approach: The ability to effectively capture a symptomatic spine image when compressed (at peak stress) may also effectively compress total Spinal Circle of Care cycle time.
The Weight on Spine Specialists
Spine specialists and their teams often face challenges in obtaining clinical proof of why their patients experience musculoskeletal spine pain when standing, as symptoms subside or disappear while lying down. Efforts to effectively identify and offer acceptable and accurate causal evidence (e.g. supporting diagnostic
images) to justify associated therapy and procedures can be costly and time-consuming.
Weak evidence risks increasing patient / physician time and costs by additional diagnostics (e.g. repeated MRIs), and delays resulting from appeals to rejected pre-authorization submission to health payers. These barriers slow the patient care cycle process and physician / practice productivity, while increasing care
and practice costs.
Spine Imaging: Evolution and Resolution Disruption
"Going back to the 1970s, there has been an interest in determining why people hurt when they stand up, and feel better when they lay down, and what mechanically happens when the spine is subjected to stress," Dr. Smith explained. Before the introduction of weight-bearing MRI exams, radiologists relied on
invasive Discogram and Myelogram contrast-dependent spinal diagnostic imaging procedures as the primary approaches to visualize the disc – and the canal, root and associated tissues. As the spine clinicians continue to discover weight-bearing MRIs, these two common invasive procedures remain in practice with
understood risks, pain and patient experience challenges.
Leveraging a non-invasive natural upright symptomatic position, with gravity’s pull, remains the ideal state to detect any motion-related spine/disc compression dependent symptoms (e.g. Dynamic Disc Herniation℠). Technology innovators, radiologists and spine specialists contributed to designing the first weight-
bearing MRI in the late 1990s. Weight-bearing MRIs remained experimental for the first 10 years. Since being integrated into practices, weight-bearing MRIs have increasingly changed the approach to spinal diagnoses and care.
Weight-bearing MRIs changes how to think about spinal imaging. Dr. Smith noted, "If you need rapid imaging or if you're imaging the brain where there are mostly qualitative differences, then higher field strength is optimal. However, in the spine is more so (about) mechanical issues where scanning during weight-
bearing is critical." The diagnosis advantages are exponential to the patient, physicians and practice.
Causal Evidence: Meeting Milliman (MCG) Care Guidelines
Crucial in today’s healthcare process is the weight on the surgeon to provide irrefutable documentation using ICD10 coding to justify their recommendations / orders, or risk pre-authorization denial – and be pulled from surgical time to support the associated appeal process.
These circumstances not only pull from patient care time, reducing patient volume and increasing practice administration costs - but more importantly - this prolongs the pain their patient must endure – while lengthening the patient circle of care cycle time - and costs.
Well-recognized are pre-authorization evidence requirements as defined in the Milliman Care Guidelines (MCG) for health payer review and approval level determination. The MCG emphasize the clinical impact of spinal conditions such as spinal instability, neural element compression, and functional impairment.
Dr. Lynch explained his experience submitting MCG-based evidence by stating “weight-bearing MRIs demonstrated more accurate evidence of compression of nerve roots in the weight-bearing state that hitherto was not seen. The report then was more accurate and gave us a stronger argument with health insurers.
Overall, we have been more successful in eliminating our denials from the start."
Both guests offered their direct weight-bearing MRI experience with the Esaote G-scan Brio tilt-able MRI. They shared how the G-Scan Brio examines the spine in real-life conditions, experiencing this technology demonstrate up to 35% more abnormalities than supine images.
Why is this important? Pre-authorization approval rates typically increase dramatically when including obvious causal evidence. For such spine cases, it is critical to include documentation of neurologic compression combined with pain diagrams and surgeon documentation of functional impairment in ICD10 coded
(computer interpretable) form. With this approach, you increase potential of mitigating the time and expense in filing appeals of insurance pre-authorization denials – thereby consuming critical provider, patient and OR time.
As Dr. Smith said, weight-bearing MRIs are designed to provide physicians with the "right procedure, for the right patient, at the right time, without being obstructed by poor coding or incomplete diagnoses."
Spine Patient and Physician Experience
An integrated approach to weight-bearing MRI of the spine combines technical, radiologic and surgical expertise to optimize the Spine Patient’s Circle of Care. Weight-bearing MRIs are particularly valuable for minimally and non-invasive spine procedures where efficient diagnosis and treatment can lower out-of-
pocket costs for patients and increased productivity for associated care providers and payers. Weight-bearing MRIs offer the sensitive, functional testing for the spine and can diminish the costs of ineffective treatment when conventional supine MRI fails to diagnose the cause of the patient’s symptoms.
In summary, capturing compressed spine images can also compress total Spinal Circle of Care cycle time. Potential impact:
• Patient care experience - enabling more accurate and speedier diagnoses, thereby determining the level of therapy and/or procedures recovery periods.
• Therapy / procedure pre-authorization request process - offering the health payer more definitive causal evidence and related ICD-10 codes, increasing the potential to reduce rejections delaying effective patient care – and time-consuming appeal processes.
• Health Payer - more accurate understanding of the true nature of functional spinal abnormality in a computer interpretable form, expediting claim processing and reducing redundant testing and ineffective treatments based upon inaccurate or incomplete diagnoses.
• Spine specialists - increased ability to more accurately and quickly manage their patients, increasing patient volume.
"Overall, this is a new frontier in imaging technology. It is redefining imaging of the spinal motion and its direct impact on nerves. The technology has caught up with the promise of 20 years ago with what physicians wanted to see. And now the new technology can give physicians the imaging without sacrificing
quality," Dr. Lynch concluded.
**Click here for webinar replay access. Click here to view the webinar slides.
**CME Update** - Webinar content has been approved for CME credit (1), Category A. Registered attendees will receive a separate communication from Esaote North America with CME credit license number verification, within the next 10 business days.
**For follow-on questions, please directly contact Sheila Hughes: shughes@esaoteusa.com The Esaote North America team can also address questions at RSNA17 / Chicago.