Minnesota hospitals MRI rates higher than average for back pain

Doctors and hospitals in Minnesota have a reputation for being thrifty, but apparently that tendency doesn't extend to treatments for low-back pain, according to the Pioneer Press.

Low-back pain usually improves or goes away in six weeks. Yet in 2008, 40 percent of outpatients with low-back pain had an MRI at Minnesota hospitals without first trying cheaper alternatives such as exercise, physical therapy, or injections, which are recommended by professional guidelines. The national average was 33 percent, based on data from the Hospital Compare website, which is based on Medicare claims.

A spokesman for North Memorial Health Care (54 percent) noted that the Medicare billings/claims data does not capture whether conversations between the patient and provider may have addressed other therapies for lower back pain.

Individual hospitals will probably use the published numbers as an incentive to improve, said Dr. Michael Rapp, director of the quality-measurement and health-assessment group at the Centers for Medicare and Medicaid Services. "Over time, I would expect the rate to fall both in Minnesota and overall," he told the Pioneer Press.

A neurologist at Regions Hospital--which had the highest rate in the state with 57 percent of outpatients with low-back pain getting MRI scans--said that the hospital was a fairly low user of testing and procedures, so he wasn't sure how to react to the Hospital Compare measure.

The Hospital Quality Alliance questioned the measures. Although the frequency of tests is measured, there's no way to know what frequency is appropriate or represents good quality, a spokeswoman for the Minnesota Hospital Association told the Press.

In a rebuttal, Rapp said that the MRI measure, which was added to the Hospital Compare website only this year, was endorsed by the National Quality Forum.

To learn more:
-read the Pioneer Press article
-see the MinnPost.com blog

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