Two-tiered MRI approach for headache cuts costs 40 percent

Neuroimaging for patients complaining of a headache is largely discouraged because few abnormalities are found. Using an abbreviated MRI sequence to determine which patients need to proceed to a comprehensive scan, however, can generate savings of more than 40 percent for payers while still catching problems at a high rate, according to a study published in the July issue of the American Journal of Roentgenology.

“If a particular MRI sequence could reliably identify the subgroup of patients likely to benefit from additional imaging sequences, it could potentially enable more efficient utilization of the scanner time, potential cost reduction, and less burden on patients,” wrote Aseem Sharma, MD, Washington University School of Medicine, St. Louis, and colleagues.

The two-tiered system suggested by the authors begins with a fluid attenuated inversion recovery (FLAIR) sequence alone. If, based on the results of this initial scan, more comprehensive imaging is warranted, then patients should receive a full conventional MRI.

To test the efficacy of using the FLAIR sequence as a gatekeeper for further imaging, Sharma and colleagues identified 245 consecutive patients with headache who received an MRI between October 2009 and July 2011. Three readers prospectively used the FLAIR sequences to diagnose abnormalities or identify the need for a comprehensive study.

The sensitivity and specificity of the two-tiered and conventional MRI approaches did not significantly differ, according to the authors.

What did differ was potential savings for payers. Assuming a 50 percent reduction in payment for the FLAIR sequence alone, the two-tiered approach would have resulted in 44.8 percent savings to the payer, reported Sharma and colleagues. Depending on the level of reimbursement for the initial scan, payer savings could range between 28.6 percent and 61 percent.

Scanner utilization time was drastically reduced as well, with average time spent in the scanner by each patient dropping from 17 minutes to 5.1 minutes. In many of the scenarios considered by the authors, the technical reimbursement rate per minute of scanner utilization was projected to increase with the two-tiered approach.

“A two-tiered approach to MRI can be attractive from a busy imaging facility’s perspective, given that the impact of the anticipated reduced reimbursements with this approach can be significantly offset by the higher throughput made possible by a commensurate reduction in scanner utilization time per patient.”

Sharma and colleagues added that a similar two-tiered approach could be applied to indications beyond headache, such as for patients with stroke, suspected cord compression, sensorineural hearing loss and others.