OK, our yearlong economic near-catastrophe has had far-reaching effects and is a ready-made excuse for all sorts of evils in the world.
wife: “Honey, why didn’t you vacuum the living room like I asked?”
husband: “Well, in this time of economic uncertainty, I felt that it would be unwise to both use more electricity for something as superfluous as vacuuming, as well as hasten the demise of our vacuum by using it before it was absolutely necessary…”
But, in fact, economic conditions do have the outward appearances of being a contributing factor in increasing rates of MRI accidents.
First, let’s draw a distinction between the economics of MRI reimbursement and the broader economic condition that we all find ourselves in.
Insurers, the organizations that pay for the vast majority of MRI exams in the US, have been incrementally cutting the prices that they’ll pay hospitals and imaging centers for MRI studies. To a degree, this has been in response to ever-growing MRI scan volumes, which have lead to some economies of scale. A few years ago, Medicare / Medicaid switched from taking incremental nibbles off of the reimbursement rate, to lopping off a huge chunk with the budgetary equivalent of a machete, called the Deficit Reduction Act (DRA). Many commercial insurers followed suit.
The accumulated reimbursement cuts from the whole cadre of insurers has taken years following the initial enactment of the DRA to reach its full effect, just in time for the bottom to drop out of the broader economy. Now MRI providers are not only getting paid less for each exam, with many patients having to fork-over a 20% copay for the cost of their MRI exam, the number of patients walking in the door has also dropped.
A trend that began with the enactment of the DRA a few years ago may actually be building momentum, namely cutting staff, or cutting staff qualifications, to reduce the operating expenses of an MRI operation.
In the grand scheme of MRI center finances, there’s very little that’s within an administrators control. There are fixed costs for the equipment and the building in which it sits. One of the few variable costs is staffing. When faced with reduced revenue per patient, many MRI providers began implementing staff cuts. Two MRI staffers on duty may be the defined ‘standard of care’, but many are getting by with one. And while a seasoned registered MRI Technologist may be the best qualified, they’re probably more expensive to hire than someone with less experience, or lesser credentials.
These staffing reductions may come at the expense of the single greatest asset to MRI safety, a trained MR Technologist. And these cuts come as an unwanted exclamation point on a string of other increased risk factors, such as increased magnet strength, greater RF deposition, greater patient acuities, and growing emergent / trauma / interventional uses. These factors, alone and in concert, are likely responsible for the 277% increase in reported MRI accidents.
So, while my headline for this entry may be a little over-simplified and over-dramatic, the economic conditions in which MRI providers operate do appear to correlate with a dramatic rise in MRI accidents. Hopefully, as we emerge from the ‘valley of financial darkness’, MRI providers who have been compelled to make some hard choices about staffing will rededicate themselves to the safety of their patients.
Clearly, I don’t mean to suggest that an improved economy will coincidentally reduce the rates of MRI accidents as a direct effect. MRI providers (some of them, anyway) are ultimately the the ones who have chosen to reallocate resources away from personnel, programs, and equipment that enhance patient safety. My hope is that the alarming trend of increasing accidents, with or without a marked economic rebound, will prompt a new evaluation of effective (and cost-effective) means of improving MRI safety.Tobias Gilk, President & MRI Safety Director Mednovus, Inc. Tobias.Gilk@Mednovus.com www.MEDNOVUS.com