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both price and quality transparency

Special Discount - Until recently, consumers had little incentive to shop for price concerning health care. They might have paid a small copay and insurance picked up the rest. But today, many people have high-deductible health plans and it may matter much more if the price an insurer negotiated for an MRI at Facility A is more than at Facility B. So why not shop for health care procedures the same way we price-shop for a computer or canned goods?

There is little evidence that the most expensive treatment or procedure always yields a better outcome. However, starting with the right diagnosis impacts all subsequent care; pinpointing quality at this stage is critical. Diagnostic imaging, for example a spine MRI, often is perceived as a commodity. If all MRI's are not that same, shouldn't we expect as much transparency and explanation of quality as we want to see for price?

Why should a patient drive 10 miles farther and pay more for an MRI done at a particular imaging facility when they can get one cheaper at the MRI Center "down the block"?

There are four major factors to the accuracy and diagnostic value of an MRI: the type of equipment, the imaging protocols (meaning which images we capture and how), who interprets with images, and the collaboration between the radiology physician and the treating physician. Any two imaging centers will have some variation in these four things; a big enough variation can have a dramatic impact on a patient's diagnosis.

What difference does equipment make?

Let's look at back and spine care. Technological advancements have given us what is called high-field, high resolution MRI. A low field system may be suitable for some disorders such as central disc herniations, but other disorders, for example small cysts compressing a nerve root in the central canal, are better seen with a high-resolution system. How good we are at detecting and clarifying these problems will determine patient care and outcomes.

What is an imaging protocol?

Protocol here means the way an image, or series of images, is obtained to get the best view possible. Even with the best equipment, if the imaging technologist has sub-optimal training and experience, or if exactly the right area is not targeted, the problem causing the patient's pain may never be correctly imaged. At Southwest Medical Imaging it is not that unusual for us to get requests from spine physicians asking us to perform an MRI on their new patients due to the poor quality of an MRI that they have undergone somewhere else.

Can you explain more about the final two variables you mentioned, expertise and collaboration?

Even with the best MRI equipment and optimal protocols, the actual detection and correct interpretation can be highly dependent on the expertise of the radiologist. At SMIL, our musculoskeletal radiologists are fellowship-trained but really that is just the first step to becoming a true expert. Experience matters. The numbers of years that radiologists practices their specialization, the number of cases that they evaluate daily and their level of collaboration with a full range of treating physicians all contribute to their degree of expertise in interpreting MRI's. Let me paint a very realistic picture; a 66-year-old women with a history of hip pain goes to three imaging centers ranging in cost from a few hundred to several thousands of dollars. She may walk out with three different diagnosis's that based on her private insurer and government treatment guidelines could results in three very different pathways, from conservative care (physical therapy) to invasive options (epidural injections and surgery). It is true that price and quality are not always connected in health care but if the price of the diagnosis is the only consideration, any incorrect diagnosis and subsequent inappropriate care, can easily become the most expensive option.

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