Date and Time
October 15, 2008
1:30 PM - 3:00 PM

Availability
Open to the public
No RSVP required

Speaker
Jacqueline Baras - M.D. and M.S. Candidate

From 2000 through 2006, Medicare spending for imaging services more than doubled-increasing to about $14 billion. Spending on advanced imaging, such as magnetic resonance imaging (MRI), rose substantially faster than other imaging services such as ultrasound and X-ray. While increases in spending may produce important net benefits for society, even if costly, it is important to tackle technology growth when higher use is not clearly correlated with higher quality of care, an example of which is MRI and low back pain.

There are many points in the delivery of care where use of MRI for low back pain can be influenced.  One point is at the clinical level through guidelines, the most recent of which for low back pain management discourages routine use of MRI.  Another way to tackle growth may be at the supply level by limiting the placement of new imaging equipment into service. This paper addresses questions of technology growth from this perspective, using Medicare data to examine, at the patient-level, the relationship between the availability of MRI units and receipt of subsequent low back pain care, specifically MRI and surgery.  Since low back surgery has not been shown to be any more efficacious than nonsurgical management, we believe that the relationship between MRI availability and quantity of care may also reflect a relationship between MRI availability and questionable quality of care. Results suggest that increases in MRI unit availability are associated with moderate increases in receipt of MRI, surgery, and repeat surgery.  Most importantly, the association of MRI availability appears strongest with earlier, rather than delayed, receipt of MRI and surgery. 

This session is an adaptation of her thesis for the Master's degree in Health Research and Policy.