We know that over-utilization of health care is a major factor that is causing our overall health care costs to rise at a rate that is far out-pacing inflation. This article from the Robert Wood Johnson Foundation addresses the overuse of MRIs, specifically with regard to lower back pain. Most lower back pain goes away on its own within a month or two, and thus an MRI within the first six weeks is likely to be a waste of money. Often the imaging is paid for by health insurance, which helps to drive premiums steadily higher for all of us.
The RWJF article details a program that has helped to curtail MRI costs by simply having treatment guidelines pop up on the doctor’s computer screen when a test is ordered – the doctor can go ahead and order the test after reading the guidelines, but apparently many times they change their minds, since the program saved almost $6 million in testing expenses in 2008.
These sort of reminders are good for both doctors and patients. Remember a few years ago when there was a public ad campaign to teach people that antibiotics are not effective against colds, and that overuse of antibiotics leads to antibiotic-resistant bugs? Perhaps we need something similar for diagnostic testing and imaging. An ad campaign that encourages people to wait a few weeks and see if their pain subsides could be a good reminder that we don’t need to incur thousands of dollars in testing expenses at the first hint of pain.
Part of the problem stems from the fact that equipment like MRI machines is becoming more ubiquitous in medical offices. According to a study detailed in Health Affairs, MRI utilization is directly tied to availability – so if an office has MRI equipment on site, their patients are more likely to receive MRIs. This makes sense, as the doctor has to recoup the costs of acquiring the machine, and also stands to make a nice profit from doing the imaging tests.
Perhaps this is where we should start. What if we implemented a system whereby doctors could not be compensated for ordering medical imaging for their patients? The imaging equipment could be strategically located throughout each city and state, but not in doctors’ offices, and not run by doctors who order the tests. If a doctor were to have no financial incentive one way or the other, we could probably assume that imaging would only be ordered when it was deemed medically necessary, and we would expect to see roughly the same rate of imaging use from one doctor to the next.