MBS review an ‘appropriate response’ to blowout in knee MRIs

GPs should no longer be allowed to order knee MRIs for over 50-year-olds, says a MBS Review taskforce which found some may be ordering the test unnecessarily.

The Diagnostic Imaging Clinical Committee’s knee working group found spending on knee MRIs had more than doubled since 2012, when GPs gained the right to order it for adults with suspected acute tears of the anterior cruciate ligament or meniscus.

But the committee questioned the utility of the referrals in patients over 50, who made up a significant proportion of referrals, suggesting knee symptoms in this age group were more likely to be caused by symptomatic osteoarthritis.

In findings released last week, the committee said there was concern about inappropriate use of the knee MRI due to the high volume performed in patients over 65, who often have coexistent symptoms of osteoarthritis “that can be difficult to distinguish from those of meniscal tear and incidental meniscal tears which are common in elderly patients with osteoarthritis”.

“This can lead to the erroneous assumption that the meniscal tear revealed by MRI in an older person with knee osteoarthritis symptoms is responsible for the patient’s symptoms, when this is not the case.”

Specialists should retain the right to order knee MRIs for all ages, the committee said.

The recommendation is an “appropriate response” to the cost blow out, said Professor Chris Maher, director of the Musculoskeletal Division at The George Institute for Global Health.

But the reform should be complemented by new MBS items for evidence-based physiotherapy, he said.

“You can’t just go around removing unnecessary care, you have to replace it with appropriate care.

“What should be happening is these people should be having some sort of a rehab program, (currently) not funded by Medicare.”

The Knee Imaging Working Group also recommended:

A cap of three GP-ordered knee MRIs per year

Removing ‘injury of collateral ligaments’ indication for knee ultrasound

Separate the MBS items for X-ray and CT scan of the knee from other extremities to allow for monitoring of use.

Remove the requirement for children under 16 to have a mandatory plain X Ray before an MRI, to reduce young patients’ exposure to radiation.

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