MRI Utilization and the Associated Use of sedation and anesthesia in a Pediatric ACO

Magnetic resonance imaging, or #MRI, is considered one of the safest technologies for looking deep inside the body, because it doesn’t carry the radiation risk of #XRays or PET scans.
“Over all, #PediatricMRI is a very safe test,” said Dr. Max Wintermark, chief of #neuroradiology at Stanford University.
“#MRI Utilization and the Associated Use of sedation and anesthesia in a #PediatricACO http://bit.ly/2ufeTmQ #ImageGently

BACKGROUND AND OBJECTIVES:
#PediatricMRI is commonly used in the pediatric population and often requires sedation or general anesthesia to complete. This study used data from a pediatric accountable care organization (ACO) to investigate trends in MRI utilization and in the requirement for anesthesia to complete MRI examinations.

METHODS:
The Partners for Kids #PFK ACO claims database was queried for #MRI examination encounters involving patients 0 to 18 years old from 2009 to 2014, with utilization expressed as encounters per 10,000 #PFK members-months. Data were limited to 2011 to 2014 to ensure consistent billing of anesthesia services. Encounters were classified according to the presence of procedure codes for anesthesia or sedation.

RESULTS:
#MRI utilization was approximately constant over the study period at 11 to 12 encounters per 10,000 member-months. The need for anesthesia increased from 21% to 28% of encounters over 2011 to 2014. The latter increase was shared across 1- to 6-year-old, 7- to 12-year-old, and 12- to 18-year-old subgroups. In multivariable regression analysis of monthly utilization, increasing need for anesthesia could not be attributed to secular trends in patient demographics or types of examinations ordered. Paid cost data were available for outpatient MRIs, and MRIs with sedation accounted for an increasing share of these costs (from 22% in 2011 to 33% in 2014).

CONCLUSION:
There was an increasing need for anesthesia services to complete MRI examinations in this pediatric population, resulting in increasing cost of MRI examinations and presenting a challenge to ACO cost containment.”
Most concerns about M.R.I.s involve people with metal, such as shrapnel, embedded in their bodies, or someone with an implanted medical device, like a cochlear implant or an older pacemaker. The imaging system’s strong magnetic field can slightly shift or heat up embedded metal and disrupt the activities of medical devices. It can also draw metal objects into the magnetic field, and there are still occasional accidents when standard safety procedures are not followed and M.R.I. magnets have sucked in hospital beds, screwdrivers, oxygen tanks and other metal objects.

“That’s why we take extreme precautions to know if a patient has a device, so we can take appropriate measures to make it safe for them, too,” Dr. Wintermark said. In some cases, people with implants or embedded metal cannot safely get an M.R.I. and must use a different scanning technology instead.

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