Connecting the dots: Who refers the most musculoskeletal imaging exams to radiologists?

Musculoskeletal (MSK) imaging has increased over the past two decades—and so has its costs to the healthcare system.

A recent study in the American Journal of Roentgenology found understanding the unique specialty referral patterns of MSK extremity imaging may help radiology practices optimize and cut unnecessary costs related to the technique.

“Little is known about which specialists most commonly refer patients for these examinations and are thus ultimately affecting the decision as to whether such examinations are performed,” wrote corresponding author Paul Harkey, with the department of radiology and imaging services at Emory University School of Medicine in Atlanta, and colleagues. “Such an understanding could be useful in efforts to reduce costs and unnecessary testing related to MSK extremity imaging.”

The team gathered provider referral data for MSK extremity imaging from the 2014 Medicare Referring Provider Utilization for Procedures for public use dataset. The referring provider specialty was determined by analyzing cross-linked Medicare provider characteristic files.

A total of 4,275,647 MSK imaging service referrals were analyzed. Listed below were the top MSK-ordering specialties:

• Orthopedic surgery (37.6 percent)
• Internal medicine (20.2 percent)
• Family practice (14.8 percent)
• Emergency Medicine (7.9 percent)
• Rheumatology (5.7 percent)

Of note were the number of orders per provider. The top MSK imaging ordering specialties by modality are as follows:

• For CT scans, orthopedic surgery (1.8 orders per provider).
• For MRI, orthopedic surgery (17.7 per provider) Sports medicine (15.5 per provider).
• Ultrasound: osteopathic medicine (1.1 order per provider).
• Radiography found orthopedic surgery, rheumatology and sports medicine ranging from 54.4 to 67.8 per provider.

“Awareness of these referral patterns may help direct future education and outreach efforts, fostering partnerships between radiologists and ordering specialties to improve resource utilization,” Harkey et al. wrote.

For example, authors suggested clinical decision support software could use the modality-specialty referral patterns to create a more directed approach to imaging order appropriateness.

“As the nation’s health care system continues to pursue value-based payment systems, knowledge of these referral patterns should provide radiologists and practice managers with a clearer representation of how ordering physicians use MSK extremity imaging services,” Harkey et al. wrote.