MRI of Knees and Shoulders Before Radiography Costly

Performing MRI before radiography on patients presenting with shoulder or knee pain, or with tendonitis, represents a potential gap in care, according to an article published in the Journal of the American College of Radiology.

Current Appropriate Criteria (AC) state that knee and shoulder pain should be first assessed with radiography before moving ahead to more costly imaging studies, except in cases of significant trauma to the knee.

Researchers from Massachusetts, Illinois, Missouri and California undertook a retrospective study to determine how often MRIs were performed before radiographs for knee or shoulder pain, and the associated costs. MRI use before radiography was also compared between patients who were on Medicare and those who were commercially insured.

The researchers found that approximately 28 percent of all knee MRIs, and 35 percent to 37 percent of all shoulder MRIs were performed without recent prior radiographs. “The MRIs performed without prior radiographs among patients with knee pain accounted for spending of $1,089,704 in the Medicare population and $4,439,394 in the commercially insured population, whereas among those with nontraumatic knee pain, the corresponding expenditure was $1,011,136 and $3,891,560, respectively,” the authors wrote. “The MRI exams performed without prior radiographs among those with shoulder pain or tendonitis accounted for spending of $1,773,486 in the Medicare population and $4,172,714 among the commercially insured, whereas among those with nontraumatic shoulder pain or tendonitis, the corresponding expenditure was $1,082,224 and $2,839,312, respectively.”

The researchers concluded that the use of MRI before radiography for knee and shoulder pain “represents a potential gap in care and should be considered as an area for establishment of performance measures.”