By The Numbers: "6"

"6" is the number of weeks that professional medical organizations indicate that providers should wait before considering ordering MRIs for patients with low back pain. Yet increasingly, medical providers are ordering MRIs at or near the onset of treatment. This is not done on the basis of medically concerning clinical findings. Instead, these films are ordered to “explore” for potential issues as opposed to “confirming” a condition. “Exploration” is not a legitimate use of MRIs.

Why Most MRIs are Unnecessary MRIs add between $2,000 - $10,000 in additional charges to consider. They have become so commonplace that many claims adjusters just accept them. This is dangerous as our research shows that these medical charges inflate overall settlements more than you think. Not only do MRI films increase the submitted medical charges, they also add to an adjuster’s impression of injury and unnecessarily inflates his or her impression of the pain and suffering value.

In most cases, MRIs are unwarranted. The proof is in the medical records of the provider who ordered them. The basis for ordering an MRI, or the lack thereof, is sometimes very evident when reviewing a healthcare provider’s records. For example, there may be no mention in the records of the MRI at all, or the provider simply noted that they were ordered without explanation. Assessing whether an MRI was warranted is critical. Choosing Wisely® summarizes the conclusions of multiple medical organizations in regard to low back pain. They are in agreement that most cases of low back pain simply don’t meet the standards for ordering MRIs. Here are a few tips on what to look for: 1. Orders for MRIs within the first 6 weeks for complaints of low back pain – even with radiculopathy – contradict the evidence-based guidelines of all professional medical organizations. MRIs are only recommended for cases with “red flags”. What’s a red flag? Suspicion of cancer, tumor or other conditions which pose a serious and imminent health threat. Low back pain doesn’t meet that standard. 2. Orders for MRIs that are not clear as to what they are being ordered to “confirm” or “rule out”. Does the provider specify?

So why are these professional medical organizations so consistent on this point? 1. Most people get better within 4-6 weeks – even without treatment. 2. The MRIs won’t change the treatment plan. See for yourself. Find the point in treatment when the MRIs were obtained. Then look at the treatment records after that date. Is there any material change in treatment after the MRIs? Are they even mentioned in the treatment plan? 3. It may lead the plan down the wrong path. MRIs can convince patients and providers that treatment is indicated when it isn’t. “Routine imaging can subject patients to unnecessary harm, by finding abnormalities that are not clinically relevant that lead to further downstream testing, spinal injections, and in some cases, surgery." – Choosing Wisely® A disc herniation alone is meaningless. Yet we are seeing increasing examples of more invasive procedures in cases where MRI findings are incidental – and the provider's records confirm it! Training is an integral part of our relationship with our customers. It is aimed at teaching adjusters and managers about techniques for review and analysis of records, as well as how to use our reports to negotiate key points on cases. The following link is a sample of the material we deliver to our customers.

The Uses and Misuses of MRIs

7 views0 comments