Overuse of knee and shoulder MRI proves costly

Skyrocketing use of MRI for knee and shoulder pain often ignores guidelines and adds millions of dollars to medical costs, according to a study published July 30 in the Journal of the American College of Radiology.

The study by Elizabeth George, MD, of Boston’s Brigham and Women's Hospital, and colleagues, looked at the percentage of MRI examinations for knee and shoulder pain or tendonitis done without prior radiography.

Knee and shoulder pain are the most frequent regional musculoskeletal disorders after low-back pain, the author said. According to American College of Radiology guidelines, radiographs should be taken for knee and shoulder pain before MRIs are done.

About 28 percent of knee MRIs and 35 percent to 37 percent of shoulder MRIs examined in the study were performed without prior radiographs, the authors said. These MRIs cost Medicare patients an extrapolated $20 million to $35 million a year.

Furthermore, between 20 percent and 23 percent of patients undergoing knee MRIs, and between 27 percent and 32 percent undergoing shoulder MRIs, did not even have radiographic exams done in the same calendar year, they wrote.

The study examined patients in the Medicare 5 percent carrier claims limited data set and privately insured patients in the Truven Marketscan Treatment Pathways database in 2010.

The MRIs performed without prior radiographs among patients with knee pain accounted for spending of $1,089,704 by Medicare patients and $4,439,394 by commercially insured patients, whereas among those with nontraumatic knee pain, the corresponding expenditure was $1,011,136 and $3,891,560, respectively, wrote the authors.

The MRI exams performed without prior radiographs among those with shoulder pain or tendonitis accounted for spending of $1,773,486 in the Medicare population and $4,172,714 among the commercially insured, whereas among those with nontraumatic shoulder pain or tendonitis, the corresponding expenditure was $1,082,224 and $2,839,312, respectively.

MRI studies have more than quadrupled in recent years, rising 353.5 percent from 1996 to 2010, while the number of radiographs rose by only 19.1 percent, wrote George and colleagues.

“MRI performed without prior radiography represents a potential gap in care and should be considered as an area for establishment of performance measures,” they suggested.