PDF(Pubmed)
Abstract：
BACKGROUND: Insurance companies often mandate six weeks of physical therapy (PT) prior to approving MRIs for patients with atraumatic rotator cuff (RTC) tears. While this is designed to limit unnecessary imaging orders, it can increase healthcare costs and delay diagnosis and surgery. This study investigated the incidence of full- and partial-thickness tears when an MRI was ordered at the time of initial consultation for shoulder pain by an orthopedic provider.
METHODS: A retrospective review of patients who had an MRI ordered upon initial orthopedic consultation for chronic shoulder pain was conducted. The primary outcome measured was the presence of RTC tears as determined by the MRI report. The cost of six weeks of PT versus the cost of immediate MRI in these patients was collected from our institution\'s financial database. ANOVA, independent T-test, and chi-square test were used to analyze the differences between groups.
RESULTS: A total of 365 patients were included. There were no significant differences in demographics between patients with full, partial, or no tears, with the exception that patients with full-thickness tears were older. Specifically, 43.0% had a full-thickness tear, 24.7% had a partial-thickness tear, and 32.2% had no tear on MRI. A total of 56.1% of the full-thickness tears proceeded to surgery. The cost of an upper extremity MRI without contrast averages $2,268, while two sessions of PT per week for six weeks totals $2,328.
CONCLUSIONS: Over 67% of MRI orders yielded a positive finding of an RTC tear and remained at 67.2% in the absence of a history of conservative treatment, validating a specialist\'s clinical suspicion for an RTC tear and indication for MRI. Pre-MRI PT to satisfy insurance requirements may therefore delay intervention and increase healthcare costs when an orthopedic provider believes an MRI is warranted for clinical decision-making.
METHODS: A retrospective review of patients who had an MRI ordered upon initial orthopedic consultation for chronic shoulder pain was conducted. The primary outcome measured was the presence of RTC tears as determined by the MRI report. The cost of six weeks of PT versus the cost of immediate MRI in these patients was collected from our institution\'s financial database. ANOVA, independent T-test, and chi-square test were used to analyze the differences between groups.
RESULTS: A total of 365 patients were included. There were no significant differences in demographics between patients with full, partial, or no tears, with the exception that patients with full-thickness tears were older. Specifically, 43.0% had a full-thickness tear, 24.7% had a partial-thickness tear, and 32.2% had no tear on MRI. A total of 56.1% of the full-thickness tears proceeded to surgery. The cost of an upper extremity MRI without contrast averages $2,268, while two sessions of PT per week for six weeks totals $2,328.
CONCLUSIONS: Over 67% of MRI orders yielded a positive finding of an RTC tear and remained at 67.2% in the absence of a history of conservative treatment, validating a specialist\'s clinical suspicion for an RTC tear and indication for MRI. Pre-MRI PT to satisfy insurance requirements may therefore delay intervention and increase healthcare costs when an orthopedic provider believes an MRI is warranted for clinical decision-making.
摘要：
背景：保险公司通常在批准无创伤性肩袖（RTC）撕裂患者的MRI之前，必须进行6周的物理治疗（PT）。虽然这是为了限制不必要的成像顺序，它可以增加医疗成本和延迟诊断和手术。这项研究调查了骨科提供者在初次咨询肩痛时订购MRI时，全厚度和部分厚度撕裂的发生率。
方法：对因慢性肩痛在初次骨科会诊后进行MRI检查的患者进行回顾性分析。测量的主要结果是由MRI报告确定的RTC撕裂的存在。从我们机构的财务数据库中收集了这些患者的6周PT费用与立即MRI费用的比较。方差分析,独立的T检验，采用卡方检验分析组间差异。
结果：共纳入365例患者。患者之间的人口统计学没有显着差异，局部,或者没有眼泪，除了全层泪液患者年龄较大。具体来说,43.0%有全层撕裂，24.7%有部分厚度撕裂，32.2%的MRI无撕裂。总共56.1％的全层撕裂进行了手术。没有对比的上肢MRI的平均费用为2,268美元，而为期六周的每周两次PT总计为2,328美元。
结论：在没有保守治疗史的情况下，超过67％的MRI医嘱显示出RTC撕裂的阳性结果，保持在67.2％。验证专家对RTC撕裂的临床怀疑和MRI的指征。因此，当骨科提供者认为MRI用于临床决策时，满足保险要求的预MRIPT可能会延迟干预并增加医疗保健成本。
方法：对因慢性肩痛在初次骨科会诊后进行MRI检查的患者进行回顾性分析。测量的主要结果是由MRI报告确定的RTC撕裂的存在。从我们机构的财务数据库中收集了这些患者的6周PT费用与立即MRI费用的比较。方差分析,独立的T检验，采用卡方检验分析组间差异。
结果：共纳入365例患者。患者之间的人口统计学没有显着差异，局部,或者没有眼泪，除了全层泪液患者年龄较大。具体来说,43.0%有全层撕裂，24.7%有部分厚度撕裂，32.2%的MRI无撕裂。总共56.1％的全层撕裂进行了手术。没有对比的上肢MRI的平均费用为2,268美元，而为期六周的每周两次PT总计为2,328美元。
结论：在没有保守治疗史的情况下，超过67％的MRI医嘱显示出RTC撕裂的阳性结果，保持在67.2％。验证专家对RTC撕裂的临床怀疑和MRI的指征。因此，当骨科提供者认为MRI用于临床决策时，满足保险要求的预MRIPT可能会延迟干预并增加医疗保健成本。
