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In-office MRI should not shift focus away from patients
Orthopedic practices with an in-office MRI must balance speed with quality
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Extremity scanners small enough to fit in most offices may seem like an obvious way for practices to improve patient care and increase revenue, but doctors should be sure patients remain top priority.
“You must be convinced you’re doing it for the right reasons,” said Bert Mandelbaum, MD, of Santa Monica, Calif.
“And never make a decision based on economics alone,” he added.
Mandelbaum is fellowship director of the Santa Monica Orthopedic Sports Medicine Research Foundation, where an in-office MRI has been in use for about a year and a half.
“It’s been a great adjunct. It’s a tremendous service to our patients and a tremendous method of enhancing our practice,” Mandelbaum said.
Other orthopedists echoed Mandelbaum’s sentiments, and all cautioned that improving quality of patient care must remain the ultimate goal of adding such equipment.
Economics
The positive economics of an in-office MRI for doctors is the ability to catch dollars that had previously gone to imaging centers, Mandelbaum said. But that also creates the potential for abuse.
Since insurance providers generally offer identical reimbursements for MRIs, the quality of an in-office MRI would not affect a practice’s financial bottom line. In other words, an office would be reimbursed equally for images, no matter how poor their quality.
“It could easily be abused, though I haven’t seen it yet,” said Andrew Deutsch, MD, of Electronic Orthopedic Imaging Associates in Los Angeles, Calif.
Deutsch is a well-known radiologist who reads MRIs for orthopedic practices, mostly in California.
He said some extremity scanners provide images comparable to the traditional large units, but quality can vary greatly from machine to machine, especially with used equipment on the market.
“There are so many varieties of scanners, and some clearly produce better images,” Deutsch said.
Deutsch said he prefers images from scanners with high Tesla field strengths, though some argue that low-field machines can also produce quality results. He also stressed the big picture concerning extremity scanners.
“You want the in-office product to meet the highest level of quality possible. You don’t want to say it’s OK to use a second-rate machine just because it’s in an office,” Deutsch said.
Patient volume important
While making money should not be the motivation behind an in-office MRI, practices must also be wary of not losing money either.
“The key issue is having a volume of patients who would utilize the machine to make it cost-effective,” Mandelbaum said.
For instance, a new extremity scanner suited for ankles, knees, elbows and wrists could cost about $250,000, according to Jack M. Bert, MD, of Saint Paul, Minn.
If such a machine does not require a shielded room, one exam a day could potentially create a break-even scenario for a practice, Bert said.
But with orthopedists typically concerned with shoulders and spines, such a small machine might not be desirable.
A $500,000 scanner that could fit shoulders and required a shielded room would require two or more scans per day to break even, Bert said, while a full-size scanner for spines will cost at least $1 million and call for three or four scans a day.
Mandelbaum said the quality of images generated by his group’s in-office scanner, which has 1.0 Tesla magnet, is superb.
Also, the scanner has allowed them to develop a method of direct access to patients on computer screens and to format the images for each patient.
“We can provide a more focused report rather than a string of x-ray packets,” Mandelbaum said.
Allows real-time interaction
Patients like the in-office scanners for the real-time interaction with physicians, who can speak to a radiologist on the phone while the patient is undergoing the MRI, Mandelbaum said.
Deutsch agreed that digital images are an advantage over hard copies, which cannot be improved by a technician or handled, shipped and stored as easily or in the same quantity as electronic picture files.
Deutsch said such services geared toward patient satisfaction are key to fully utilizing the positive aspects of an in-office MRI.
“I’m quite positive about it if it’s done right, but there’s a little bit more to it than just bringing a machine into the office,” Deutsch said.
“If you’re going to offer the service, you ought to provide a quality product on the same level as if a patient were referred out to a hospital or imaging center. It has the capability of being as good, but it requires people demanding it be as good,” Deutsch said.