Do you really need an MRI for that aching back or sore shoulder?
For the past three years, more than 2,000 Minnesota doctors have used a computer program to help answer those questions. They plug in information about a patient, and a program using national guidelines tells them if a CT scan or MRI is a good choice -- or if there's something better.
That simple step has helped save an estimated $28 million a year by eliminating thousands of unnecessary tests, according to the Institute for Clinical Systems Improvement (ICSI), a health research group in Bloomington, Minn.
Starting next year, ICSI will make the program available free to doctors throughout Minnesota, in what some say could be a national model for curbing health costs.
"Doctors aren't infallible ... sometimes they choose the wrong thing," said Cally Vinz, a vice president at ICSI, which sponsored the project with some of Minnesota's largest health plans and medical clinics.
They discovered that physicians were choosing high-tech tests "that weren't useful" about 10 percent of the time, she said, wasting money and unnecessarily exposing patients to radiation.
The project, funded by health insurers, was such a success that the federal Medicare program is considering following in Minnesota's footsteps, Vinz said.
The project grew out of insurers' alarm over the skyrocketing cost of CT scans and other high-tech procedures, which was growing by double digits nationwide. At the same time, doctors were upset by the insurers' attempts to crack down on those tests by screening all requests. Doctors would have to call an 800 number and get permission.
Both sides realized "there's got to be a better way to do this," Vinz said. In 2007, they joined with ICSI to launch an experiment. Several medical groups agreed to try a computerized program, developed by HealthPartners, to guide doctors when they order CTs, MRIs and sophisticated heart scans. The health plans agreed to waive doctors' "prior notification" requirement.
"I know a lot of (doctors) were skeptical," said Dr. Barry Bershow, vice president at Fairview Health Services. But many "came to love this quickly."
Instead of waiting hours for approval by phone, the doctors get an answer instantly. A popup screen invites them to fill in patient information, and the program rates the proposed test's usefulness based on guidelines from the American College of Radiology and other medical specialty groups. If another test is an option, that will pop up, too.
Among the common mistakes, Bershow said: Doctors were ordering too many MRIs, particularly for headaches and low back pain, that had little chance of affecting treatment but cost an average of $1,000.
In some cases, experts say, doctors order needless tests out of fear of lawsuits, or because a patient demands it.
Dr. Keith Wittenberg, a St. Paul radiologist who collaborated on the project, said the computer program helps weed out the wasteful tests by showing doctors the scientific evidence. It's "a very valuable feedback tool," he said
Still, some are dubious about a computer program second-guessing their decisions. "Everyone's goal is to keep health care costs under control," said Dr. Daniel Randa, a neurologist in Coon Rapids, Minn., who was not part of the ICSI project. He worries that a computer system could be "too rigid and unyielding."
Under the program, doctors can order the tests they want. But ICSI said it has affected their decisions. In 2007, the number of high-tech scans in Minnesota stopped growing and has been stable for four years.
Starting in January, Minnesota health plans will pick up the cost of a new computerized system from Nuance, a Massachusetts company. Any doctor who uses it will be able to bypass the health plans' prior notification process.