Sometimes Better Medical Equipment Isn't the Answer

Improved medical technology and data tools can be helpful in improving value-based care, but they aren't always the key factors in providing accurate, cost-effective care for patients. Here's why.

As bundled payments and value-based care have taken over healthcare, many medical device manufacturers have introduced new products promising more accurate care and new services aimed at helping caregivers improve efficiency and cut costs. Yet new products and services aren't the only inputs in the value-based care equation. 

Richard Herzog, MD, executive director of the Quality Research Institute (QRI), discussed his research on the wide variability in MRI reports during the Spreemo QRI Summit held in New York City on October 21. He pointed out that while having up-to-date technology is important, the quality of an MRI report depends most on the person conducting the imaging study. 

"You can do a terrific study on a high-field MRI system and a terrible study on a high-field MRI system. There's no guarantee field strength will guarantee a good imaging study," Herzog said. "To me, equipment is important, the sequences they're doing [are] also important, but still to me the most important part is who is running your study."

Radiologists who are trained in a sub-specialty are more likely to produce accurate MRI reports in that specific area of expertise, Herzog explained. 

MRI accuracy is important because it can often determine what treatments a patient receives next. In addition, a serious--or scary-sounding--diagnosis can affect the patient's outlook. Though many doctors will interpret MRI images themselves, some do depend on the report they receive. "There's little doubt MRI generates a cascade of both therapeutic and diagnostic procedures . . . the actual direction of your patient will be determined critically by what information is used," Herzog said. 

Since there are many factors that affect a patient's clinical outcomes and because many of these determinants, like surgical procedures, different clinicians, rehabilitation protocols, take place long after an MRI, it can be hard to determine the quality of an MRI. But, an MRI report can be judged by its accuracy, Herzog said. 

Herzog conducted a study to examine the variability in the diagnostic accuracy of MRI studies. Herzog, who is also the director of Spinal Imaging at Hospital for Special Surgery (HSS) in New York City, worked with one HSS patient who had back and leg pain. That patient was sent to ten various imaging centers around the New York area over a three-week span for MRI reports. An MRI study was also performed at HSS at the beginning and end of the test period to ensure there were no changes. The study was funded by The Spreemo QRI and performed via a partnership with Hospital for Special Surgery and Thomas Jefferson University. 

"What we found was not surprising to me, but still quite surprising to many people who take care of patients, is that there was not one spine finding in all of these studies that was actually the same in all the different reports. In fact, only about 30% of the findings were ever reported in only one of the reports," Herzog said. 

The findings also showed over 12 errors per study.

Herzog told the audience at the Spreemo QRI Summit that he believes MRI report accuracy can be improved with radiology sub-specialization, training, and other factors. "We hope to demonstrate in the future what qualifications actually . . . predict how radiologists will do," he said.

Higher accuracy in MRI reports could potentially lead to decreased costs and more accurate diagnoses and eventually, patients, providers, and payers might be able to use information on MRI accuracy to choose an imaging center, Herzog forecasted. 

"I think what we can do with this information for the future is that with consolidation of networks, by really focusing on quality, the value of MRI, is to validate the accuracy of centers around the country through QA [quality assurance] systems," he said. "Hopefully that will be a catalyst for improvement and also a catalyst for directing the network providers/payers which centers to go to, the ones that have the highest quality centers."

Marie Thibault is the managing editor at MD+DI. Reach her at [email protected] and on Twitter @MedTechMarie.

[Image courtesy of STUART MILES/FREEDIGITALPHOTOS.NET]