When Docs Own MRIs, Back Pain Scans Increase: Study

WEDNESDAY April 27, 2011 -- Doctors are far more likely to refer patients complaining of lower back pain for an expensive MRI scan if they own or lease such imaging equipment, a new study indicates.

The Stanford University School of Medicine researchers also found that after orthopedists bought MRI equipment, their patients were significantly more likely to have back surgery within six months of seeing the orthopedist for back pain.

The study author noted that MRI and surgery for lower back pain "are quite controversial" because there are no proven benefits.

"Patients should know that at the end of the day most people with low back pain do not need an imaging test, and an even smaller number end up needing surgery," said Dr. Jacqueline Baras Shreibati, a physician resident at Stanford.

Shreibati noted that the test and surgery may have been appropriate for some of the patients in the study.

Spending for one year for patients having an MRI increased about $4,100, most likely due to the back surgeries, the study found.

One expert noted that lower back pain often "improves on its own" and surgery should be a last resort.

"I'm amazed that we allow this," said Dr. Anders Cohen, chief of spine surgery and neurosurgery at Brooklyn Hospital Center.

But if you're a doctor with MRI equipment, "it makes sense" financially to use it, said Cohen, also an assistant professor of neurosurgery at Weill Cornell Medical Center in New York City.

He compared doctors with MRI equipment to a "shop owner with a new machine."

"If you're the owner and you can make money banging on the new machine, well, it's human nature. You're going to start banging on it," he said.

To protect themselves from unnecessary tests and surgery, patients "need to be part of the process," said Cohen. They need to ask about the reason for the test, and whether the doctor owns the MRI equipment or has a monetary stake in it.

Patients should expect a physical exam with a health history taken, not a quick referral for an MRI, said Cohen.

Noting that doctors of all specialties own diagnostic equipment or have stakes in labs where they send their patients, Cohen said, "this is the way of medicine now."

Anomalies picked up by MRI scans are common and often not the cause of the pain, according to Cohen.

"Everything else [medically] should be tried first," unless serious symptoms suggest a more dire condition, he said.

The study looked at Medicare claims from 1998 to 2005 by primary care doctors and orthopedists, identifying 25 percent of all "low back pain" doctor visits but not including patients who had herniated disks and narrowing of the spine. A jump of 2 percent to 4 percent in referrals for scans occurred immediately after doctors bought or leased MRI equipment, the study found.

Of 740,467 doctor visits that included MRI referrals, 78,914 were to 8,988 orthopedists, and 661,553 to 85,842 primary care doctors. Of these 1,271 orthopedists and 1,033 primary care doctors owned or leased MRI equipment.

In one analysis, there was a 13 percent increase in MRI use among orthopedists after they acquired the imaging equipment. For primary care doctors, the increase was even larger, at about 32 percent.

But orthopedic patients had a 34 percent increase in back surgery within six months of the first visit to a doctor after they acquired imaging equipment. No significant increase in surgery occurred for patients of primary care physicians.

The study is published in the April issue of the journal Health Services Research.

More information

To learn more about MRI, visit U.S. Food and Drug Administration.

Posted: April 2011


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