Gratuitous MRI Exemplifies Healthcare Waste

MRI Unnecessary for Diagnosing Osteoarthritis of the Knee

A new study released today at the American Academy of Orthopaedic Surgeons’ annual meeting, found that patients seeking treatment for arthritic knees should be given a weight-bearing X-ray before following up with more expensive MRI.

“MRIs are being used in excess. Many doctors no longer talk to or examine their patients. Instead, they are going right for the technology,” said the study’s lead author Dr. Wayne Goldstein, a professor of orthopedics at the University of Illinois.

Researchers randomly selected 50 patients who had total knee arthroplasty to see if they had an MRI in the two years prior to surgery.

64% of the patients did have an MRI which was ordered by their primary-care or orthopedic physician. More than half of the patients did not have any X-rays prior to their surgical consultation.

The MRI did not provide any additional value that could not be provided from an X-ray.

“This is another example of over-utilization of the health-care system. It has become easier to go for the high-cost imaging. On average, an X-ray can cost less than $150, while an MRI can cost around $2500,” commented Dr. Goldstein.

Imaging now consumes 10-15% of Medicare payments to physicians, compared with <5% 10 years ago. Going forward, imaging costs are expected to grow 20% annually.
Medicare will reimburse doctors more than $400 per MRI but only around $43 for a four-view X-ray.

Goldstein and his co-authors believe that the main reason for MRI over-utilization is a lack of education, “We fix this problem through educating physicians on the appropriate use of MRIs. We also need to educate our patients. Virtually every adult experiencing a knee problem should first have an appropriate set of X-rays before considering an MRI, which has been marketed as the premier diagnostic tool, so patients often come into the office expecting, even demanding, an MRI. Physicians need to look at why they are ordering an MRI and consider whether it is truly necessary.”

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