Better Health: Smart Health Commentary Better Health (TM): smart health commentary

Article Comments

Minnesotans Get More Lower-Back MRIs: Why?

Kudos to Christopher Snowbeck and the St. Paul Pioneer Press for digging into new Medicare data to report that the state the newspaper serves is out of whack with the rest of the country in how many expensive MRI scans are done on Minnesotans’ bad backs.

Snowbeck artfully captures the predictable rationalization and defensive responses coming from locals who don’t like what the data suggest. Because what they suggest is overuse leading to overtreatment. So here’s one attempt a provider makes to deflect the data:

“The Medicare billing/claims data, which this report is generated from, would not capture conversations between a patient and provider that may have addressed alternative therapies for lower back pain,” said Robert Prevost, a spokesman for North Memorial Health Care. “It’s important to recognize the limitations of this data.”

No, data don’t capture conversations. But wouldn’t it be fascinating to be a fly on the wall during those many patient-physician encounters that led to an MRI to see what level of truly informed shared decision-making (if any) took place?

The story includes other excuses from local providers along the lines of “the data are outdated…we’ve changed…we’re better now…that can’t be right…it’s not us!” When have you ever seen a story on health care data that didn’t have these predictable reactions? It reminds me of The Tobacco Institute continually rejecting any new finding that showed new harms from smoking. When you don’t like the data, damn the data. For most of the history of medicine we had no outcomes data to show patterns of practice or what happens to people over time. Now that we’re starting to collect some such data, vested interests find that information is a menacing thing.

Instead we can learn from it, even if it is a little surprising or embarrassing.

The story captured a key question about “what’s the right rate of MRIs?” Excerpt:

“(a) spokeswoman for the Minnesota Hospital Association (said) “It is impossible to make judgments from the data … on whether or not clinicians ordered too many, too few or just the right number of imaging tests.”

Bingo. And that’s why the data are important whether you live in a high-use or low-use area. As Dartmouth’s Jack Wennberg has been saying for decades, we don’t know the right rate of utilization of many medical interventions. But the variations across the country show that patients may not be fully informed, may not be told about the tradeoffs of benefits and harms, and may not be provided a truly shared decision-making encounter. Until true reform occurs in these patient-physician encounters, you can forget about getting overuse, overtreatment and healthcare spending under control.

Snowbeck and the Pioneer Press did a good job of digging and finding an important local story.

And where was the much larger, much better-staffed Minneapolis Star Tribune on this story? The same paper that just stole away Snowbeck’s colleague Jeremy Olson who used to cover healthcare for the Pioneer Press? Deafeningly silent. I had actually written to a key staffer at the Star Tribune recently asking when/if the state’s biggest paper was going to mine the data from the new Medicare database to see if there were any important local findings. I got no response. I’ve not seen a story in the paper on it. And I couldn’t find one after I did an online search. Maybe I missed it. But regardless, thank goodness for a little remaining competition between two newspapers in a metropolitan area. And on this one — apparently — the little guy won the day big time.

*This blog post was originally published at Gary Schwitzer's HealthNewsReview Blog*


You may also like these posts

Read comments »


Comments are closed.

Return to article »

Latest Interviews

IDEA Labs: Medical Students Take The Lead In Healthcare Innovation

It’s no secret that doctors are disappointed with the way that the U.S. healthcare system is evolving. Most feel helpless about improving their work conditions or solving technical problems in patient care. Fortunately one young medical student was undeterred by the mountain of disappointment carried by his senior clinician mentors…

Read more »

How To Be A Successful Patient: Young Doctors Offer Some Advice

I am proud to be a part of the American Resident Project an initiative that promotes the writing of medical students residents and new physicians as they explore ideas for transforming American health care delivery. I recently had the opportunity to interview three of the writing fellows about how to…

Read more »

See all interviews »

Latest Cartoon

See all cartoons »

Latest Book Reviews

Book Review: Is Empathy Learned By Faking It Till It’s Real?

I m often asked to do book reviews on my blog and I rarely agree to them. This is because it takes me a long time to read a book and then if I don t enjoy it I figure the author would rather me remain silent than publish my…

Read more »

The Spirit Of The Place: Samuel Shem’s New Book May Depress You

When I was in medical school I read Samuel Shem s House Of God as a right of passage. At the time I found it to be a cynical yet eerily accurate portrayal of the underbelly of academic medicine. I gained comfort from its gallows humor and it made me…

Read more »

Eat To Save Your Life: Another Half-True Diet Book

I am hesitant to review diet books because they are so often a tangled mess of fact and fiction. Teasing out their truth from falsehood is about as exhausting as delousing a long-haired elementary school student. However after being approached by the authors’ PR agency with the promise of a…

Read more »

See all book reviews »