A new study (Abstract Available Here) just published in the journal Health Services Research explores the question of whether physician ownership of an MRI increases the number of scans performed and more importantly does it result in increased surgical rates. The study looked at both Orthopedic Surgeons and primary care physicians who begin billing for the performance of MRI procedures, rather than referring patients outside of their practice for MRI. In other words, what happens after you buy an MRI and stop sending individuals to the imaging center. Well not surprising the physicians in both groups changed their practice patterns to use more MRIs for their patients with low back pain. If the story stopped there we would only be talking about just another waste in healthcare. Unfortunately, you guessed it, the increases in MRI use also let to increases in low back surgery rates. In fact, if your surgeon owns the MRI machine you are 1/3 more likely to end up having back surgery! As physical therapists we have an obligation to inform our patients about their condition in an evidence informed way. Part of that conversation focuses around the favorable prognosis of low back pain and that imaging is only needed if we need to rule out serious pathology, and furthermore imaging bears little relation to pain. We should now make sure our patients ask if the MRI is owned by the surgeons and inform our patients about the result of this research. -Tim Flynn
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