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Tens of Thousands of Back Pain Patients Overtreated in Six Health Plans, According to HealthCore Study
Date:3/16/2009

s increased 65 percent -- more rapidly than overall health expenditures -- from 1997 or 2005; however, there's no evidence to suggest that the outcome of individuals with back pain has improved.(3)

HealthCore's analysis determined that a number of patients with back pain received inappropriate MRIs, X-rays, CT scans, and, in some cases, unnecessary surgeries. While the number of surgeries was small in comparison to the overall number of individuals with back pain, they greatly increased the cost of caring for patients with back pain.

"We also have concerns for our members' safety in exposing them to unnecessary radiation," Nussbaum said. "A lumbar spine CT, for example, exposes a person to as much radiation as he or she would expect to receive from 65 X-rays. When these procedures are unnecessary, they should be avoided."

The HealthCore study analyzed medical and pharmacy claims data for 172,377 members in WellPoint health plans in six states, and found that the majority of patients with lower back pain receive care for less than six weeks, which is consistent with previous studies indicating that most patients with back pain improve after six weeks.(4,5)

Some key findings from the study include:

  • 52 percent of patients with low back pain were treated by their doctor for six weeks or less.
  • Among those low-risk members treated for six weeks or less, 7 percent received an MRI, at an average cost of about $600 per procedure.
  • About $1.8 million could have been saved by the health care system if half of these members who received MRIs during the first six weeks of reporting back pain had avoided it.
  • About $1.3 million could have been saved by the health care system if 75 percent of those who received a second, and likely unnecessary, MRI avoided it.
  • Although less than 1,000 low-risk back pain patients (
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SOURCE WellPoint, Inc.
Copyright©2009 PR Newswire.
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