A new U.S. Department of Veteran Affairs and Stanford (Calif.) Health study found between 30 percent and 50 percent of lumbar spine MRIs are inappropriately ordered, according to Scope. The American Journal of Managed Care published the study.
The researchers wrote lower back pain patients can often undergo conservative treatment, like exercise. Additionally, many patients' back pain corrects itself.
CMS wrote guidelines about lumbar spine MRIs, indicating conditions that require immediate scans (HIV, trauma, cancer, spinal surgery). If the patient doesn't fit the guidelines, CMS suggests physical therapy or chiropractic care first.
Here are five key notes:
1. The study found inappropriate MRIs totaled $13.6 million.
2. The researchers found 24 percent of medical providers order 74 percent of the inappropriate MRI scans.
3. Some believe the high rate of unnecessary lumbar spine MRIs is due to the fee-for-service model. If surgeons are paid for MRI regardless of indications, they may be more likely to order them.
4. Some surgeons order radiographic tests for medicolegal reasons; if the patient sues, they'll have additional evidence their initial diagnosis and non-surgical treatment recommendation was correct. Because VA physicians are salaried and aren't too concerned about malpractice issues, the researchers hoped to uncover further indications for the high rate of lumbar spine MRIs.
5. Radiographic findings sometimes prove misleading, focusing on aspects that don't address patients' symptoms.