Questionable Skeletal Imaging Ranks Near Top of Health Cost Culprits


A consensus group of primary care physicians has found that ordering images for low back pain and DXA scans for women younger than 65 are top contributors to the high cost of medical care.


When a consensus group of doctors last spring announced their chosen candidates for the most common questionable procedures ordered by primary care physicians in the US, they hadn't yet counted up the price tags of the individual items. Now they've run those numbers.

After the most costly practice -- prescribing brand-name rather than generic statins -- the primary-care choices that have the second- and third-greatest impact on the national cost of medical care relate to skeletal imaging.

The cost of using brand-name statins ran to a whopping 10 figures -- almost $6 billion -- in 2009, says the Good Stewardship Working Group of the National Physicians' Alliance. Only 3 items ran to 9 figures, and of those the top 2 were skeletal imaging procedures: Ordering DXA scans for women between the ages of 45 and 64 ($527,433,733) and ordering CT or MRI scans or X-rays for patients with back pain ($175,403,922). Fourth on the list of high-cost questionable procedures was ordering antibiotics for children with sore throats.

The report behind these figures appears in the October 1 issue of the Archives of Internal Medicine.

The working group, composed of internists, family physicians, and pediatricians, was funded by the American Board of Internal Medicine to identify the most commonly used procedures in primary care and to test them against the medical evidence. The resulting list of common but questionable procedures was validated by surveys among a much larger group of primary care physicians, and the final list was first published online last May, also in the Archives of Internal Medicine. 

The Working Group points out an important difference between the 2 lists. Most of the primary care procedures that the process originally identifed as extremely common  but usually unnecessary (for instance, routine ordering of urinalysis or complete blood counts) don't have much financial impact, because their unit cost is negligible. This would not be true, of course, for MRI or DXA.

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