By Jeffrey R. Carlson, MD
As an Orthopaedic spine surgeon, I rely heavily on MRI to assist with diagnosis, surgical planning and monitoring of my patient’s post-surgical recovery. Highly accurate musculoskeletal imagery allows me to make an accurate diagnosis, which affects treatment options for my patients’ health. I also should consider the financial well-being of my patient in any healthcare recommendation that I make for them, including a diagnostic MR scan. How can we, as healthcare providers, take a more active role in not only ordering accurate diagnostic tests, but also those that are the most cost-effective?
MR Scanning is a technology that has and will continue to revolutionize what we know about the human body. The larger the magnet Tesla rating, the better the images. 7T (Tesla), 10.5T and 11.7T scanners are now available; the US Government has a 21T scanner, although the machine is too small for human use. These tech monsters are currently very costly, with enhanced patient and technician safety concerns that make their purchase and operation beyond the reach of all but the most well-endowed research and academic settings.
In orthopaedics, we prefer images from a 1.2T scanner or above, simply because the images are so much better and musculoskeletal issues are more easily discernable. It’s a waste of time and money to send a patient for a scan where the magnet isn’t sufficiently powerful to produce an accurate and clear image. Radiologists and Orthopaedists alike don’t like blurry, fuzzy or shadowy views of their patient’s anatomy when trying to make a diagnosis, and oftentimes, the scan will have to be redone at a facility with at least a 1.2T magnet.
Physicians don’t typically contemplate financial issues for the patient when treating acute illness. However, our patients would be much better served and more content with their healthcare experience if we did. Before referring a patient for an expensive diagnostic procedure such as an MR scan, we should consider the amount for which the patient will be responsible after insurance, for co-payments or co-insurance, or if they choose to self-pay.
It’s no secret that hospital MR scans cost 2 to 5 times that of a scan done in a non-hospital-owned facility. With large insurance deductibles, a patient may be held responsible for a large portion of the bill, sometimes over $1,000, even at an “in-network” facility. We are in a unique position of trust with our patients. They expect their healthcare providers to know more about their healthcare needs than they do, and to guide them in the best treatments.
Patients shop around for healthcare services, read on-line reviews, and ask friends and family for recommendations before they put their trust in us. If we send our patients for inferior tests that don’t give good information or are extremely expensive, they feel like their physician is not concerned about their time, their feelings OR their pocketbook. Physicians would do well to remember the importance of the “whole” patient before recommendations are made.
Jeffrey R. Carlson, MD is the President and Managing Partner of Orthopaedic & Spine Center in Newport News, VA. He holds a fellowship in Orthopaedic Trauma surgery and a combined Neurosurgery-Orthopaedic fellowship in complex spine surgery from Brigham and Women’s Hospital in Boston. osc-ortho.com
