Low-field MR vindicated at workers' comp hearing

Manufacturers and users of low-field MRI scanners are breathinga little easier in California. Members of a physicians councilcharged with reforming the state's workers' compensation insurancesystem have moved a step closer to shelving a controversial proposalto deny workers' comp reimbursement for low-field MRI scans.

The California Industrial Medical Council met in Los Angeleson Feb. 18 to discuss the proposal, as well as other issues involvedin the council's review of the workers' comp system. The systemhas come under fire for skyrocketing costs and is believed tobe a hotbed of waste, fraud and abuse (SCAN 2/24/93).

California's legislature formed the IMC to provide medicaladvice on workers' comp coverage to the state Division of Workers'Compensation, which is revising the system's fee schedule.

Insurance companies participating in the system have claimedthat low-field MRI scans contribute to higher costs because alarge number of scans must be repeated due to poor image quality.

Last year Dr. Michael Bronshvag, a member of the IMC reviewingworkers' comp MRI payments, proposed that the system deny reimbursementfor almost all low-field scans, defined as those below 0.5 tesla(SCAN 2/10/93). The only low-field scans allowed would have beenfor obese or claustrophobic patients.

Bronshvag's proposal sent shock waves through the state's imagingcenter industry. Low-field MRI manufacturers were also shockedat the unpleasant prospect of being shut out of a market thatpays $266 million a year for radiology services.

The proposal was short-lived, however. At the February meeting,Bronshvag retreated from the position and instead recommendedthat the workers' comp system make image quality, not magnet strength,the main criterion for reimbursement.

Testifying at the IMC meeting were several radiologists whodisplayed low-field MR images that vindicated the units, accordingto Bronshvag.

"The radiologists' pictures showed low-field-machine workthat was of good quality," Bronshvag said.

Recent improvements in low-field technology have improved imagequality to the point that it is comparable to mid- and high-fieldunits, rendering obsolete the earlier advisory to deny low-fieldreimbursement.

"In 1993 magnet size is not as determining of qualityas it was in 1991," Bronshvag said. "The situation haschanged. If the situation changes, you change the advisory."

THE IMC WAS SCHEDULED TO VOTE on Bronshvag's recommendation, butpostponed the vote until its next meeting to allow the CaliforniaRadiological Society time to comment on the issue. The societyhas been advising the IMC on its review of radiology reimbursement.

The CRS had initially discouraged the use of low-field magnets,recommending that they be used only for claustrophobic or obesepatients. This advice formed the basis for Bronshvag's initialproposal to deny low-field payments. But at a Feb. 27 meeting,CRS members decided to recommend that field strength not be theonly criterion used to determine image quality, according to CRSexecutive director Robert Achermann.

The CRS is drafting a letter to the IMC on protocols for workers'comp reimbursement of radiology procedures that incorporates thesociety's advice on low-field MRI. The IMC is scheduled to makea final vote on the issue at its next meeting at 10 a.m. March18 in the San Francisco International Airport Hilton Hotel.

The IMC vote will be forwarded as an advisory opinion to theDivision of Workers' Compensation, which will make the final decisionson workers' comp reimbursement changes.

If the IMC does back off on the low-field issue, imaging centersusing low-field magnets and the vendors who make them can resteasy. Centers who scan patients in the workers' comp system, however,will likely have to meet tighter quality assurance criteria toensure that they receive reimbursement for scans.

"The idea is to weed out the bad guys and not penalizethe good guys," said Dr. Jay Mall, president of the CRS."If (revised standards) help weed out the bad guys, thatwould be a goal which the CRS would support."