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Doctors' financial ties may lead to needless MRIs

By Lindsey Tanner
AP Medical Writer / November 30, 2011
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CHICAGO—There may be good reason to ask about financial ties if your doctor orders an expensive imaging test for your aching back: Patients whose physicians own the equipment are more likely to get scans they might not need than those whose doctors have no financial interest, a small study suggests.

Researchers analyzed reports on 500 MRI scans performed on patients with lower back pain that had been sent for review to Duke University. Of the scans with normal results, 106 were ordered by orthopedic surgeons who owned the machines versus 57 by doctors without financial ties.

The normal scans accounted for about half of those ordered by surgeons with financial connections, compared with about a quarter in the other group. The authors only examined the scans, so there's no information on the patients' medical history or outcome.

But the results suggest that some doctors who own MRI scanners use them excessively on patients who probably don't need them, to help pay for the expensive equipment and make a profit, said study co-author Dr. Ramsey Kilani, a radiology instructor at Duke University.

"Once you own a scanner, you have an incentive to run it 24 hours a day," Kilani said.

The study isn't the first to suggest that overtreatment is a risk when doctors have a financial stake in medical care they order, and others have questioned the usefulness of imaging tests for back pain, but the research "helps to quantify the degree of overutilization," Kilani said.

Medicare bars that kind of financial relationship but there's an exemption for in-office medical scanners versus off-site machines, Kilani said.

Kilani declined to identify the city or the two orthopedic offices involved in the study, citing research confidentiality agreements, but said similar results likely would be found in other cities.

The study was presented at this week's Radiological Society of North America meeting in Chicago.

MRI scanning equipment generally costs more than $1 million. A scan of the lower back can cost patients close to $2,000, and Kilani said doctors who own the machines receive a fee that can total more than $1,000 per scan.

The study involved adults who had MRI scans to search for causes of lower back pain. The researchers reviewed results of 250 scans ordered during a recent six-month period by orthopedic surgeons who owned MRI scanners and 250 scans ordered by surgeons who had no financial stake.

About one-third of the scans studied showed no abnormalities -- 106 were ordered by doctors with financial ties, versus 57 ordered by the other group. Patients in the group without financial ties were slightly older -- 57 on average versus 50, which could partly explain why that group had more abnormal results.

San Francisco physician Dr. Rita Redberg, who as editor of the Archives of Internal Medicine has highlighted overtreatment in medicine, noted that most lower back pain gets better without treatment. MRIs can lead to needless and risky surgery for harmless abnormalities, and the study doesn't answer whether any of the scans should have been performed, she said.

The Archives journal published a paper earlier this year listing the top five procedures with limited benefits and potential risks in primary care medicine; imaging tests for most cases of lower back pain within the first six weeks of symptoms topped the list.

Severe back pain that gets progressively worse likely warrants a scan; otherwise, it may make sense for patients to ask if physicians ordering scans owns the equipment, Kilani said. That doesn't mean arguing with their doctors, but doctors should be free from bias and having a discussion about reasons a scan is being ordered, and the benefits and risks of the scan is a good idea, he said.

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AP Medical Writer Lindsey Tanner can be reached at http://www.twitter.com/LindseyTanner

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