"You will need to get an MRI." Those are common orders given to patients who go to the doctor with joint pain and possible arthritis. But, is the MRI order being given before the doctor talks to the patient and obtains their medical history? Does the MRI order precede the physical examination? Are x-rays considered before utilizing an MRI?
Those are questions raised in a study presented at the 75th Annual Meeting of the American Academy of Orthopaedic Surgeons. It suggests that MRIs are used in excess to diagnose osteoarthritis in place of medical history, physical examination, and x-ray evidence.
The Expense of MRI v. X-ray
The over-utilization of MRI is expensive and wasteful, according to researchers. For example, the information needed to diagnose knee osteoarthritis can be obtained using x-ray. While an x-ray can cost less than $150, the cost of an MRI is about $2,500.
Medical imaging accounts for 10 to 15% of Medicare payments to physicians. Ten years ago, medical imaging accounted for less than 5%. The cost of medical imaging is expected to continue soaring at an annual rate of at least 20%. Suffice to say, it's an expensive business.
In 2008, doctors will be reimbursed more than $400 for each and every MRI by Medicare . A 4-view x-ray, which is more effective for viewing osteoarthritis and is used by most orthopedic doctors, will reimburse doctors a bit more than $43.
Studying Over-utilization of MRI
Researchers reviewed a group of 50 patients who had total knee replacements because of osteoarthritis to see if they had an MRI in the two years prior to surgery. Of the 50 patients, 32 had an MRI ordered by their primary care or orthopedic doctor. Researchers concluded that the MRI did not provide any information that could not have been obtained by x-ray. More than half of the group had no x-rays before the consultation about surgery.
Points to Remember
Patients with knee pain should have x-rays before an MRI is considered, unless there is suspicion of a more serious or uncommon condition, such as avascular necrosis. Since MRI has been marketed as the premier diagnostic tool, patients and doctors need to be educated and re-think the diagnostic process. X-ray should come before MRI in the majority of knee osteoarthritis cases. Don't be afraid to ask your doctor why he is ordering an MRI. It's important to have an active voice in the decisions being made about your health care.
Over-utilization of MRI in the osteoarthritis patient. 2008 AAOS Meeting. Gordon AC, et al.