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MedSolutions recommends that health plans review their data for two recent trends in imaging requests:
Each of these trends could lead to unnecessary high-tech studies and inflated costs. As a Screening Tool Dr. Jennifer Meko, Western Region Medical Director at MedSolutions, said an example of the first situation occurs when the patient says, “I am having knee pain,” and the physician automatically orders an MRI of the knee. “In cases such as these, the high-tech imaging study is essentially being used as a screening tool and as a substitute for a thorough history and physical examination,” said Dr. Meko. “Imaging studies should be used as the final arbiter of a differential diagnosis, not as a screening test.” MedSolutions recently reviewed cases where a physician other than an orthopedic specialist had ordered an MRI of the knee for a patient complaining of knee pain. MedSolutions initially denied these requests with suggestion for evaluation by an orthopedic specialist first. Ultimately, less than half of the patients had a knee MRI performed. “Not having an MRI was significant convenience for those patients who didn’t need to have the test as well as savings for the health plan,” said Dr. Meko Dr. Meko said one of the deciding factors in approving the test was a more focused physical exam given to the patient’s knee in the second visit. Specialists
Requirements “Many specialists who require patients to have an imaging study prior to a visit do this as a time-saving tool and not because it is a best practice or will optimally benefit the patient,” Dr. Meko said. “The same rules apply to a specialist as to a primary care physician. We expect them to use radiology to verify a diagnosis generated by history and physical examination. ” At the same time, she said the company has heard anecdotally from specialists that up to 75% of MRI studies that accompany patients when they come for referral end up being of no benefit in the diagnosis and treatment of that patient. Dr. Meko often conducts this type of research to review and validate the guidelines used in MedSolutions’ preauthorization program. She said the ultimate goal is to benefit patients and their care while protecting them from unnecessary radiation or contrast agents. When making updates, she assesses the entire diagnostic process to ensure the best first test when using radiology. Dr. Meko is available at jennifer.meko@medsolutions.com.
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