Musculoskeletal

Millions wasted on low value care: knee MRI increased sevenfold in over 55s


Experts have decried a rapid increase in GP ordering of MBS-subsidised knee MRI scans, which they say is likely to have been unnecessary low value care, wasting hundreds of millions of healthcare dollars.

The rate of publicly funded knee MRIs in over 55-year-olds increased about sevenfold between 2003 and 2017 with many likely to be outside MBS indications of acute knee trauma with possible meniscal or anterior cruciate ligament tears, according to a study in the Australia and NZ Journal of Surgery.

Using MBS claims data, the study showed knee MRIs increased from 216/100,000 to 1509/100,000, with a spike in 2013 when a GP item number became available for MBS-subsidised knee MRI scans.

Led by Dr Leon Smith, Mona Vale Hospital, Sydney, the study authors said the large number of MRIs requested by GPs from this time was only minimally offset by fewer referrals from specialists in private practice.

Knee MRI use was consistently highest in the 55-64 year age group although the biggest increase in use was seen in the 85+ age group.

The study found knee arthroscopy had decreased overall during the study period – mostly between 2014 and 2017.

Knee replacement surgery, however, had continued to increase steadily from 534.6/100,000 in 2003 to 840.4/100,000 in 2017 (relative increase of 57%).

The study authors said the large regional variation in MRI and arthroscopy rates strongly suggested that their use was not primarily driven by clinical indication.

“Many (or even most) of the MRI tests and arthroscopies identified in our study may have been unnecessary,” they said.

“Besides potential harm to patients, unnecessary MRI and knee arthroscopy represent wasted healthcare resources and public money.”

They said the MBS cost for knee MRI items in 2017 was $96,870,620 – money which could perhaps be better directed towards evidence-based interventions including weight management and exercise.

“Similarly, another benefit of not performing large numbers of unnecessary procedures would presumably free up resources for those who do genuinely need the procedure,” Dr Smith told the limbic.

He said figuring out what was currently being done wrong was the first step towards making sensible decisions regarding resource utilisation.

“… we should still be very careful about using technology including imaging scans that may not have clinical utility, simply to reassure the patient. Rather the focus should be on finding ways to educate, empower and reassure our patients without sending them for scans they would not otherwise need.”

The study authors noted that since November 2018, and based on advice from the MBS Review Taskforce, GPs were no longer able to request MBS-subsidised knee MRIs for patients from 50 years.

Dr Smith said such policy tweaking would certainly help reduce low value care.

“There’s always more to be done though. We noted that several facilities in NSW managed to reduce their arthroscopy rates by requiring explicit approval within their orthopaedic surgery departments before going ahead with the procedure, so that’s certainly another approach that seems to have worked.”

He said the dramatic increase in MRI rates seen over the study period would suggest a need to search out other opportunities to optimise use of the technology.

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