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Published on: August 8, 2019
Effect of Public Reporting on MR Imaging Use for Low Back Pain
Cecilia M Ganduglia1, Mark Zezza1, Jonathan D Smith1
1From the Department of Management, Policy and Community Health, University of Texas School of Public Health, 1200 Pressler St, Houston, TX 77030 (C.M.G., L.F.); The Commonwealth Fund, New York, NY (M.Z.); Centers for Medicare & Medicaid Services, Baltimore, Md (J.D.S.); and Department of Radiology, University of Texas School of Medicine, Houston, Tex (S.D.J.).
Purpose:
To determine whether magnetic resonance (MR) imaging examination rates for low back pain before conservative therapy in the Medicare and privately insured populations changed after introduction of a Centers for Medicare & Medicaid Services public reporting initiative.
Materials And Methods:
Institutional review board approval was obtained, with waiver of informed consent. A retrospective study was performed by using fee-for-service claims data from Medicare and a commercial carrier (Blue Cross Blue Shield of Texas [BCBSTX]) for Texas enrollees. OP-8 was calculated, which is a publicly reported measure as of 2009 of the proportion of MR imaging examinations performed for low back pain without history of conservative therapy. For 330 463 MR imaging examinations, OP-8 rates, trends, and regional variation were analyzed for 2008-2011 within different outpatient settings-outpatient hospital department (OHD) and nonhospital outpatient department (NOD)-according to payer. Largest-volume hospitals were also evaluated within the Medicare population.
Results:
No significant reduction was found in annual OP-8 values for Medicare or BCBSTX (Medicare OHD, 0.35 for 2008 vs 0.36 for 2009 [P = .01]; BCBSTX OHD, 0.42 for 2008 vs 0.44 for 2009 [P = .03]; Medicare NOD, 0.33 for 2008 vs 0.35 for 2009 [P < .0001]; and BCBSTX NOD, 0.43 for 2008 vs 0.42 for 2009[P = .23]). These changes were not sustained during subsequent years in the BCBSTX population, and there were no further changes in Medicare rates. Among hospitals with highest Medicare volumes, those with the highest OP-8 rates in 2008 were associated with the highest decrease in their measure. (The annual change rate was negative for all years, with 2008 as the reference [P < .0001 for 2009-2011].) Hospitals with the lowest OP-8 rates had increases in OP-8 rates, which persisted in following years (P = .006 for 2009, P = .037 for 2010, and P = .004 for 2011). Hospitals with baseline OP-8 rates in the 25th-75th percentile remained relatively steady over time.
Conclusion:
No evidence was found that public reporting (OP-8) reduced MR imaging rates for low back pain without conservative therapy in either Medicare or commercially insured populations in hospital or nonhospital settings.
Insights
Public reporting of magnetic resonance (MR) imaging rates for low back pain did not reduce examinations before conservative therapy in Medicare or commercially insured patients. The Centers for Medicare & Medicaid Services initiative showed no significant impact on imaging utilization.
Area of Science:
- Radiology and Imaging
- Health Services Research
- Public Health Policy
Background:
- The Centers for Medicare & Medicaid Services implemented a public reporting initiative (OP-8) to influence magnetic resonance (MR) imaging utilization for low back pain.
- The OP-8 measure tracks the proportion of MR imaging examinations for low back pain performed without prior conservative therapy.
- Understanding the impact of such initiatives is crucial for optimizing healthcare resource allocation and patient care pathways.
Purpose of the Study:
- To evaluate the effect of the Centers for Medicare & Medicaid Services public reporting initiative on MR imaging examination rates for low back pain.
- To determine if the initiative altered the frequency of MR imaging performed before conservative therapy in Medicare and privately insured populations.
Main Methods:
- A retrospective analysis of fee-for-service claims data from Medicare and a commercial insurer (Blue Cross Blue Shield of Texas) in Texas.
- Calculation and analysis of the OP-8 measure for 330,463 MR imaging examinations between 2008 and 2011.
- Comparison of OP-8 rates across different outpatient settings (hospital and nonhospital) and payer groups, including an evaluation of high-volume hospitals.
Main Results:
- No significant reduction in annual OP-8 values was observed for either Medicare or commercially insured populations across outpatient settings.
- While some hospitals with initially high OP-8 rates showed decreases, those with low baseline rates experienced increases, negating overall impact.
- The observed changes were not sustained in the long term, particularly for the commercially insured group.
Conclusions:
- The public reporting initiative (OP-8) did not demonstrate effectiveness in reducing MR imaging rates for low back pain prior to conservative therapy.
- The findings suggest that public reporting alone may not be sufficient to modify physician behavior regarding advanced imaging utilization in this context.
- Further strategies may be needed to curb potentially unnecessary MR imaging for low back pain in both Medicare and commercially insured patients.
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