Medical Wonders : MRIs Save Lives but Cost Millions--and Does the Medical Community Need So Many?
A gleaming new machine began operating this winter at Inglewood’s Centinela Hospital Medical Center: a magnetic resonance imaging device with the extraordinary power to peer inside the human body.
The same type of machine was also installed across town at Daniel Freeman Memorial Hospital.
Like two neighbors buying identical cars, the competing Inglewood hospitals had decided to invest in the same MRI machine: the state-of-the-art Signa system from General Electric Medical Systems, with a price tag hovering at $2 million.
Hospital officials say the choice was pure coincidence. “We don’t exactly call each other up and say, ‘Hey, what kind of equipment are you getting?’ ” a Centinela spokesman joked.
In Southern California, it seems these pricey high-tech machines are being installed faster than swimming pools.
At least 11 fixed MRI devices are now operating in the South Bay--more than one-third the number serving the entire country of Canada. Four of these were installed in the past two years. At least two other hospitals--now served by mobile MRI scanners--are considering buying their own fixed units.
MRI devices are fast becoming a symbol of a central dilemma in American health care: They represent the latest in medical technology, but they come at a steep price in an age when regulators and insurers are straining to control medical costs. Moreover, critics question whether some MRI tests are being ordered unnecessarily at doctor-owned clinics, driving up the cost of health care.
Magnetic resonance technology offers doctors an unparalleled ability to diagnose cancers and other ailments by giving doctors crystalline images of the brain, spine and other parts of the body.
But they also are costly, with prices for a scan in the South Bay ranging from $500 to $1,500.
To some, the idea of MRI scanners popping up across the Los Angeles basin represents an imaging revolution that will diagnose diseases faster, more safely and painlessly. They say the scanners can actually save money by pinpointing problems without exploratory surgery or other invasive procedures.
To others, however, the MRI explosion is an example of the medical community’s love affair with technology, as scanners become de rigueur for hospitals, physicians and patients alike.
“There’s that belief that it’s our right as Americans to get that MRI if you need it, and get it immediately,” said Gerald Kominski, an assistant professor at the UCLA School of Public Health, who warns that some uses of MRI scans turns them into “a very expensive complement to X-rays.”
Yet few deny that MRI technology is reshaping the face of medicine.
Working without radiation, an MRI machine produces clear-cut images that can make X-rays look like foggy 19th-Century relics.
The images are created when a patient lies inside a massive, oven-like cylinder. Bursts of magnetic fields, combined with radio waves, trigger signals from hydrogen atoms in the patient’s tissues. A computer translates those signals into black-and-white images of the body’s interior.
MRI technology can provide doctors with detailed looks at body parts in higher contrast than the older scanners.
Some newer scanners, like those at Centinela and Daniel Freeman hospitals, move even farther along the high-tech spectrum by producing “magnetic resonance angiography,” or MRA, which are pictures of arteries and veins. That allows doctors to monitor blood flow and diagnose such problems as aneurysms.
The new Centinela MRI scanner replaced an older model located in a trailer. Today, the new scanner is doing about 375 procedures a month; the cost ranges from $967 for knees to a high $1,450 for an entire spine.
Across town, the Daniel Freeman scanner is doing about 180 procedures a month, at an average cost of $1,000.
The South Bay scanners fall into three different categories. Some, like the one at Centinela, are operated by hospitals. Others are run by private imaging centers, and some are mobile units shared by several health facilities.
As the popularity of MRI increases, more hospitals are investing in their own scanners. Kaiser Permanente Hospital in Harbor City recently acquired an MRI device. San Pedro Peninsula Hospital, which now borrows a mobile MRI a few days a week, plans to install its own scanner within a year.
But Torrance’s Little Company of Mary Hospital continues to transport its patients by ambulance to a nearby imaging center, Del Amo Diagnostic Center, in which the hospital is a part owner.
The hospital has no immediate plans to add an in-house MRI scanner, said President Mark Costa, who points to uncertainties in the current health-care climate such as increased review by insurers.
Even as more scanners are being installed, the entire MRI industry is coming under stepped-up scrutiny.
Many units are operated by physicians’ partnerships, raising questions about whether doctors should be referring patients for tests at businesses in which they have a financial interest.
One study found that in Florida, where more than 90% of the imaging centers are partially or wholly doctor-owned, physicians were ordering more procedures than doctors in Baltimore, where physician ownership was less common.
Legislation has been introduced in Congress to forbid doctors from referring patients to facilities in which they have a financial interest.
By contrast, hospitals with their own MRI scanners do not directly control how many patients are referred for procedures, which some call a safeguard against overuse. And some hospital officials stress what they call the benefits of hospital MRI ownership over that of physicians’ groups.
“In a hospital setting, like this hospital, they have strict quality controls,” said Dr. Michael S. Shaub, medical director of radiology at Centinela.
Because MRI scanners are essentially unregulated in California, neither county nor state officials could offer an exact count of how many scanners are operating in the South Bay or the state as a whole.
The state Office of Statewide Health Planning and Development is now conducting an exhaustive study to establish the number of California scanners and their locations.
One study reported that as of last year, MRI scanners were operating at more than 300 sites in the state. Nationally, the number of MRI devices is estimated at 2,700 to 3,000, compared to just 27 throughout Canada. That means Canada has one MRI device for roughly every million people, compared to one MRI for about 92,000 people in the United States.
Does the United States have more scanners than it needs?
“It’s a very difficult question to answer, because we don’t have a good standard in terms of what defines need,” said Dr. Earl Steinberg, director of the Johns Hopkins University Program for Medical Technology and Practice Assessment.
Steinberg said Americans want to contain health-care costs, but at the same time are terrified of reining in a new technology for fear of hindering its development.
“We call this the medical arms race, because that’s what it is,” said David Langness, spokesman for the Hospital Council of Southern California. The fault lies not with individual hospitals, but with a system that lacks a clear, cogent health-care policy to deal with spending on high-tech equipment, Langness said.
Some are convinced MRI proliferation is driving up health-care costs because physicians may be tempted to use them for unnecessary procedures when an X-ray or other, less costly tests may serve the same purpose.
Dr. Beverly Morgan, a UC Irvine professor of pediatrics, undertook her own tally and concluded that 41 MRI devices are operating in Orange County alone. She favors a system in which facilities would have to prove the need for expensive machinery before being allowed to buy it.
But supporters insist the MRI is not ballooning health-care costs.
An MRI scan “can actually reduce costs by avoiding surgery,” said Phyllis Piano, a spokeswoman for General Electric Medical Systems in Waukesha, Wis.
At facilities like Centinela, officials are quick to defend their decision to bring in the new MRI.
Centinela’s Shaub said medical treatment depends on an accurate diagnosis.
“Especially with angiography, we may be talking about life-and-death situations,” Shaub said. “So we don’t want anyone to have to wait for an MRI.”
