More Scans for Back Pain by Doctors Who Bill for MRI

Having an MRI increases likelihood of surgery in orthopedic patients with low back pain

WEDNESDAY, May 25 (HealthDay News) -- Patients with low back pain in the care of primary care physicians or orthopedists who own or lease magnetic resonance imaging (MRI) equipment are more likely to receive an MRI, according to a study published online April 21 in Health Services Research.

Jacqueline Baras Shreibati, M.D., and Laurence C. Baker, Ph.D., from the Stanford University School of Medicine in Los Altos, Calif., examined the relationship between use of MRI and subsequent surgery in Medicare beneficiaries with nonspecific low back pain between 1998 and 2005. Non-radiologist primary care physicians and orthopedists who began self-referral for MRI or acquired an MRI instrument between 1999 and 2005 were identified. Patients were traditional, fee-for-service Medicare beneficiaries who visited an orthopedist or primary care physician with nonspecific low back pain, with no claims for low back pain in the previous year. The association between MRI, surgery, and health care spending was assessed, and results were adjusted for demographic and socioeconomic covariates, and month, year, and physician-fixed effects.

The investigators found that acquisition of MRI equipment by a physician had a strong correlation with patients receiving MRI scans. Receipt of an MRI scan increased the probability of having surgery by 34 percent in patients of orthopedists but not in the patients of primary care physicians.

"Orthopedists and primary care physicians who begin to bill for the performance of MRI procedures, rather than referring patients outside of their practice for MRI, appear to change their practice patterns such that they use more MRI for their patients with low back pain," the authors write.

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