Why do Minnesota patients get more low back MRIs?

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Kudos to Christopher Snowbeck and the Pioneer Press for digging into new Medicare data to report that the state the newspaper serves is out of whack with the rest of the country in how many expensive MRI scans are done on Minnesotans’ bad backs.

Snowbeck artfully captures the predictable rationalization and defensive responses coming from locals who don’t like what the data suggest. Because what they suggest is overuse leading to overtreatment. So here’s one attempt a provider makes to deflect the data:

“The Medicare billing/claims data, which this report is generated from, would not capture conversations between a patient and provider that may have addressed alternative therapies for lower back pain,” said Robert Prevost, a spokesman for North Memorial Health Care. “It’s important to recognize the limitations of this data.”

No, data don’t capture conversations. But wouldn’t it be fascinating to be a fly on the wall during those many patient-physician encounters that led to an MRI to see what level of truly informed shared decision-making (if any) took place?

The story includes other excuses from local providers along the lines of “the data are outdated…we’ve changed…we’re better now…that can’t be right…it’s not us!” When have you ever seen a story on health care data that didn’t have these predictable reactions? It reminds me of The Tobacco Institute continually rejecting any new finding that showed new harms from smoking. When you don’t like the data, damn the data. For most of the history of medicine we had no outcomes data to show patterns of practice or what happens to people over time. Now that we’re starting to collect some such data, vested interests find that information is a menacing thing.

Instead, we can learn from it, even if it is a little surprising or embarrassing.

The story captured a key question about “what’s the right rate of MRIs?” Excerpt:

” (a) spokeswoman for the Minnesota Hospital Association (said) “It is impossible to make judgments from the data … on whether or not clinicians ordered too many, too few or just the right number of imaging tests.”

Bingo. And that’s why the data are important whether you live in a high-use or low-use area. As Dartmouth’s Jack Wennberg has been saying for decades, we don’t know the right rate of utilization of many medical interventions. But the variations across the country show that patients may not be fully informed, may not be told about the tradeoffs of benefits and harms, and may not be provided a truly shared decision-making encounter. Until true reform occurs in these patient-physician encounters, you can forget about getting overuse, overtreatment and health care spending under control.

Snowbeck and the Pioneer Press did a good job of digging and finding an important local story.

And where was the much larger, much better-staffed Star Tribune on this story? The same paper that just stole away Snowbeck’s colleague Jeremy Olson who used to cover health care for the Pioneer Press? Deafeningly silent. I had actually written to a key staffer at the Star Tribune recently asking when/if the state’s biggest paper was going to mine the data from the new Medicare database to see if there were any important local findings. I got no response. I’ve not seen a story in the paper on it. And I couldn’t find one after I did an online search. Maybe I missed it. But regardless, thank goodness for a little remaining competition between two newspapers in a metropolitan area. And on this one – apparently – the little guy won the day big time.

Addendum on July 26: Earlier I missed this graphic that enhanced the Pioneer Press story.


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Mike Pierce

July 25, 2010 at 9:35 pm

Gary – Great to see more scrutiny based on factual data. Too long has healthcare efficacy been veiled due to poor access to data (not that it didn’t exist, but that it wasn’t easily accessed and reported on).
At Expert Medical Navigation (www.exmednav.com), we are not only promoting patient decision support but also the use of data to prove our hypothesis that informed patients make better decisions, and that better decisions reduce overuse and mis-aligned incentives. We are tracking outcomes to see the impact that patient education has when applied prior to the occurrence of elective procedures. Stay tuned…
BTW – We are not only fans of Wennberg and the Dartmouth approach, but we actually are working them to expand the use of shared-decision practices. Hope we get to Minnesota soon!