Here's what's wrong with health care: MRI for tennis elbow

Mundane Pointless Stuff I Must Share (MPSIMS)
#1

Seriously.

I took my kid in for his pre-baseball physical. During the examination he mentioned that his elbow hurt. The doctor poked it, and then wrote up a referral for him to go to a sports medicine clinic.

Now so far, that sounded fine. I figured they would tell him to work on his form when throwing and hitting and maybe offer some other pointers other than what I know, which is to ice the elbow down after playing and maybe take an Advil.

But…no. The sports medicine people wrote up a referral for him to have an MRI.

Now at this point I pulled the plug. I care about my kid but–holy shit. An MRI is for sick people, not 13-year-olds with tennis elbow! I feel kind of stupid about following the referral to sports medicine in the first place.

After I said no way to the MRI, the imaging place called me. To make sure I understood what I was giving up. I asked them what an elbow MRI cost. $1465, of which my insurance would pay 85%. Or, if I wanted to self-pay, $460. (So in other words, they are taking advantage of third-party payors by upping the cost.)They thought (of course they did) he should go ahead with it, just to make sure he hadn’t already damaged his cartilage.

Okay, I’m an old fart, but in my day doctors could figure out whether there was cartilage damage without an MRI. Even as recently as five years ago a physical therapist figured out how to fix my damaged rotator cuff without an MRI. Her attitude was, “We’ll try this, if it doesn’t work, then maybe you’ll need an MRI to see if we need to go in there.” That was back when I had no insurance. I supposed if I’d had insurance I would have gone to a doctor who said, “MRI first, then treatment.” Which just seems backwards.

I guess I am a mean and heartless person but my take is that if baseball continues to make his elbow hurt, despite ice and ibuprofen, he should give up baseball.

#2

K, I just had surgery for tennis elbow and no one had to do an MRI first.

#3

I knew it. All they wanted to do was extract $$$. From the insurance co. and from me.

#4

“And if you stopped jerkin’ off so much, you wouldn’t have ‘Tennis Elbow’!”

#5

LOL. My sister has calcified tendinitis in her shoulder and people at work keep telling her to stop jerking off her boyfriend and it would go away.

#6

Partly this is defensive medicine, but I think that most of it is sheer greed. A lot of people WILL get this done if it’s suggested, and especially if it’s pushed.

And yes, they are definitely taking advantage of the insurance companies.

#7

Insurance companies know this is going on. They regularly negotiate rates with hospitals and will not uncommonly refuse to cover a particular hospital or group if they can’t come to an equitable agreement. One year I had to change insurance away from a major group that most people would recognize because they couldn’t reach an agreement with the hospital I work at, until about a year later.

A lot of places (where I work included) will cut fees for self-pay people out of humanitarian reasons/due to their non-profit status, and may end up cutting fees further or writing off other bills.

#8

Steroid injection for me.
“Where does it hurt?”
“Here.”
“You’re done. Next!”

Quick, effective, and cheap. Granted, there obviously are different levels of injury and perhaps kids should not be given a steroid but the point being thank goodness there are doctors out there that don’t try and game the system.

#9

I went in to an orthopedic clinic with a sprained ankle and suspected tendon damage. The doctor had me get an MRI because I run and he wanted to make sure my marathon training wasn’t delayed. It turned out to everybody’s suprise to be a stress fracture. <shrug>

#10

Did your son’s doctor actually say, “I think it’s tennis elbow, let’s do an MRI,” or are you presuming it’s a simple case of tennis elbow and therefore the MRI is unnecessary? Did you ask him why he wanted to do the MRI? Is there any possibility of a ligament tear?

Indeed, part of the problem in health care is over use of diagnostic tests. Another part is ignoring small problems that then turn into big problems.

#11

Yep. I don’t have insurance. My clinic gives me a 30% discount for same-day payment. When I had my gall bladder out, the hospital bill was discounted 20%. The clinic offered the discount as soon as they learned I had no coverage, but I had to ask the hospital.

But still, $11K for a simple same-day cholecystectomy? The elastic leggings were $85. I looked for an Armani logo.

#12

Soft tissues don’t show up well on x-rays. Diagnosing soft tissue injuries are more easily done by MRI. You are dealing with a 13 year old and his growth rate. The Dr. may want to make sure it’s only tennis elbow and not worse damage.

My example of some waste.
After my accident, I had a wheelchair. My insurance was renting it for $95 per month for a planned term of 18 months. The chair retails for $325.

#13

For me it was cortisone, cortisone, you need surgery, cortisone, cortisone, you really should have surgery we can’t give you any more cortisone, surgery.

#14

An MRI costs the imaging company very little to run. The machine, however, costs very much, whether you use it or not. If MORE people would get MRI’s, the per patient fee could be much lower. So, perhaps one problem with health care is the under use of diagnostic tests.

#15

Doctors (and my parents) have been telling my kid sister for years that her knees hurt because she’s 6 feet tall and active. She got an MRI the other day, turns out she’s needed surgery all along, and now there’s some pretty extensive damage.

#16

Only with exceedingly warped logic does this make sense: you’d have more people taking unnecessary MRIs, and thus wasting money, while the smaller number of people who need the MRIs would save money. And the “very little” it costs to perform the test would go up.

#17

I’m not sure it’s “exceedingly warped.” maybe a little warped. Here’s the point. The machines probably cost millions. Say 100 people per month get an MRI, and they each pay $1000. say the cost to run the MRI for 20 minutes is $20 dollars (plus the technician. The technician is there all day anyway, the $20 is insignificant. If 400 people per month used the machine you could cut the cost to $250 per patient and pay off the cost of the investment just as fast.

I don’t advocate “unnecessary” MRI’s, but let’s use them for any indication (assuming we’re willing to cut the fee)

#18

There are three problems here: first, you’re leaving out the cost of maintenance which is on the order of $1million a year (something about needing special liquids to cool the magnets, a cost I assume that goes up with usage). Second, you’re assuming that capacity could just be quadrupled when there is a definite upper limit to the amount an MRI can be used (if for no other reason than they take 30-90 minutes to perform). Third, it leaves out the fee paid to the radiologist, which can be considerable.

#19

put the radiologist on salary. Your other points seem valid.

#20

Paying off the cost of the investment in the MRI machine is not my primary concern. I’m more concerned with maximizing the correct use of the MRI and minimizing unnecessary scans, which waste the patient’s time and the patient and insurer and clinic’s money.