Variation in spinal MRI can muddle employer-based health plans

Costs of imaging procedures are often compared to one another when medical price shopping. It’s instinctive: All MRI machines are more or less the same, right?

However, a study published in Spine Journal found a tenfold difference in price among ten different imaging centers across the country, using a “secret shopper” who was experiencing lower back pain radiating down her right leg.

Further, each center reported different findings with different treatment recommendations. This low level of inter-physician agreement means some of the interpretations are inaccurate, resulting in delayed treatment or poor outcomes, according to lead author Richard Herzog, MD, Director of Spinal Imaging at the Hospital for Special Surgery in New York.

“Importantly, it would be an omission not to add that the payer community heavily relies upon MRI reports during utilization and authorization review procedures,” wrote Herzog et al. “As a result, an incorrect diagnosis on an MRI has the potential to significantly delay authorization of appropriate care that in turn can negatively impact patient outcomes.”

While the researchers didn’t include the prices in their study, they told Forbes contributor Leah Binder the price did not reflect the accuracy of the diagnosis. This has implications for employer-based health plans, according to Binder.

“When quality is all the same, decisions can pivot on price alone,” she wrote. “Unfortunately, no such procedures exist; extreme variation is the hallmark of our healthcare system.”

Read her full article by following the link below: