Elizabeth George1, Stavros Tsipas2, Gregory Wozniak2, David A Rubin3, David J Seidenwurm4, Kesav Raghavan1, William Golden5, Colleen Tallant6, Mythreyi Bhargavan-Chatfield6, Judy Burleson6, Frank J Rybicki7. 1. Applied Imaging Science Laboratory, Department of Radiology, Brigham and Women's Hospital, Boston, Massachussetts. 2. AMA, Chicago, Illinois. 3. Musculoskeletal Radiology Section, Department of Radiology, Washington University School of Medicine, St. Louis, Missouri. 4. Sutter Medical Group, Sacramento, California. 5. Department of Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas. 6. American College of Radiology, Reston, Virginia. 7. Applied Imaging Science Laboratory, Department of Radiology, Brigham and Women's Hospital, Boston, Massachussetts. Electronic address: frybicki@partners.org.
Abstract
PURPOSE: Available data are limited on the level of adherence to established guidelines for appropriate utilization of MR in musculoskeletal imaging. This study estimates the percentage of MRI examinations for knee and shoulder pain or tendonitis performed without prior radiography, which thus may fall outside the ACR Appropriateness Criteria for the Medicare and commercially insured populations. METHODS: The percentage of MRI examinations for knee and shoulder pain or tendonitis performed without prior radiography was estimated among patients in the Medicare 5% carrier claims limited data set and among commercially insured patients in the Truven Marketscan Treatment Pathways database in 2010. RESULTS: Approximately 28% of all knee MRIs, and 35%-37% of all shoulder MRIs were performed without recent prior radiographs. The extrapolated expense of these potentially unwarranted MRIs in the entire fee-for-service Medicare population was between $20 and $35 million. Between 20% and 23% of patients undergoing knee MRI, and 27%-32% undergoing shoulder MRI, did not have radiographic examination at any point before the MRI in the same calendar year. CONCLUSIONS: MRI performed without prior radiography represents a potential gap in care and should be considered as an area for establishment of performance measures.
PURPOSE: Available data are limited on the level of adherence to established guidelines for appropriate utilization of MR in musculoskeletal imaging. This study estimates the percentage of MRI examinations for knee and shoulder pain or tendonitis performed without prior radiography, which thus may fall outside the ACR Appropriateness Criteria for the Medicare and commercially insured populations. METHODS: The percentage of MRI examinations for knee and shoulder pain or tendonitis performed without prior radiography was estimated among patients in the Medicare 5% carrier claims limited data set and among commercially insured patients in the Truven Marketscan Treatment Pathways database in 2010. RESULTS: Approximately 28% of all knee MRIs, and 35%-37% of all shoulder MRIs were performed without recent prior radiographs. The extrapolated expense of these potentially unwarranted MRIs in the entire fee-for-service Medicare population was between $20 and $35 million. Between 20% and 23% of patients undergoing knee MRI, and 27%-32% undergoing shoulder MRI, did not have radiographic examination at any point before the MRI in the same calendar year. CONCLUSIONS: MRI performed without prior radiography represents a potential gap in care and should be considered as an area for establishment of performance measures.
Authors: Gary J Young; Stephen Flaherty; E David Zepeda; Koenraad J Mortele; John L Griffith Journal: J Gen Intern Med Date: 2020-01-23 Impact factor: 5.128
Authors: Erica Mulcaire-Jones; Andrea M Barker; J Peter Beck; Phillip Lawrence; Grant W Cannon; Michael J Battistone Journal: J Clin Rheumatol Date: 2022-03-31 Impact factor: 3.902