More MRIs may reignite debate

  • Article by: CHEN MAY YEE
  • Star Tribune
  • July 26, 2008 - 4:44 PM

Along a two-mile stretch of France Avenue in Edina, medical providers have installed so many powerful magnetic resonance imaging (MRI) scanners that radiologists joke that anyone driving through with a pacemaker should beware.

Come September, there'll be a new one.

That's when a new high-tech imaging center is opening in Southdale Medical Center, on the corner of France Avenue and 65th Street.

Called Suburban Imaging, it's a joint venture involving one of the biggest radiology groups in the Twin Cities, Suburban Radiologic Consultants; the state's third-largest hospital and clinic group, Fairview Health Services; and 21 physician groups in the area.

The center will offer "the best imaging in the state and equals anything at the Mayo Clinic," said Dr. Owen O'Neill, president of Minnesota Orthopedic Specialists, a partner in the venture.

The 12,000-square-foot center, which cost $6 million to build and equip, will offer state-of-the-art MRI, CT, PET/CT, nuclear medicine, computed radiography and ultrasound services.

Its opening is likely to reignite a debate on whether Minnesota has too many diagnostic imaging facilities, encouraging doctors to order unnecessary procedures and pushing up medical costs. It's also likely to raise the ethically thorny question of whether doctors should refer patients to a facility in which they have a financial stake.

"Imaging has been an area of concern for a long time," said Julie Sonier, director of the Minnesota Department of Health's health economics program, which does reviews of major medical investments. "Issues about the concentration in Edina have also been a concern for some time."

A 2007 Health Department report said there was anecdotal evidence in Minnesota that physician investments in facilities led to financial conflicts of interest and overuse.

Sonier said the Health Department will be sending a letter soon to partners in the venture requesting more information.

The technologies have taken off in recent years because they help diagnose and treat life-threatening diseases such as cancer and heart disease.

Doctors also are finding promising new uses. At the Mayo Clinic, researchers are using MRI and other imaging methods to study cognitive function and gauge a patient's risk of progressing to Alzheimer's disease.

A scan costs several hundred to several thousand dollars, depending on what type it is and where it's done.

In a report to Congress last month, the U.S. Government Accountability Office said Medicare spending on imaging services more than doubled to $14 billion from 2000 to 2006, an average growth rate of 13 percent a year, compared with 8.2 percent for all Medicare physician-billed services.

The GAO report noted a wide discrepancy in use across the country -- with Minnesota right in the middle -- suggesting that not all of it was necessary or appropriate. It also noted that physicians referring patients to their own practices for imaging formed a "major spending driver."

The report's authors urged Medicare to follow the lead of some private plans that require physicians to notify the plan before ordering a service.

Last year, several Minnesota insurers did just that. Bloomington-based HealthPartners found that the number of scans fell to 97,000, from 104,000 the year before. That translated to savings of $6.6 million, or 10 percent of HealthPartners' total imaging bill.

"The race to embrace these new technologies tends to overlook whether we use them correctly," said Dr. Pat Courneya, a medical director at HealthPartners. "Any unnecessary tests make health care more unaffordable for the 47 million uninsured Americans, small businesses, and has implications for Medicare."

Of the new center in Edina, Courneya said: "The investment in more capacity, while not surprising, is a little bit disappointing."

The largest independent chain of imaging centers, the Center for Diagnostic Imaging, was approached more than a year ago to be a partner but declined.

"Our view would be that there are more than enough scanners in the Twin Cities market to handle the demand," said Chief Executive Bob Baumgartner.

Oversight by hindsight

So how much is too much?

It's a difficult question, said Sonier of the Health Department.

"There is not consensus or a standard for how much is needed," she said. "The fact that technology is rapidly changing makes this difficult as well."

The Health Department reviews investments in medical equipment of more than $1 million, but only after they're made. In fact, it was a letter from Fairview last summer reporting a $1 million investment in an imaging joint-venture that put the new Edina center on the Health Department's radar.

The department has further questions on the partnership, Sonier said, including how it's structured. Under a federal law designed to curb physician self-referral, physicians aren't allowed to refer Medicare or Medicaid patients to facilities in which they have a financial relationship. There is an exception for services that are located in the same building, but not all the physician groups involved in the Edina venture are in the same building.

With such retrospective reviews, the Health Department can't undo an investment. But if it finds something it doesn't like, it can require that provider to seek prior approval for any big investment for the next five years.

Five years ago, the Health Department deemed the new LifeDiagnostics center in downtown Minneapolis unnecessary. The center was opened by Hennepin Faculty Associates (HFA) at a cost of $2.87 million.

A marketing survey showed that downtown workers wanted a downtown location, HFA said. But the Health Department, noting the five other "quality facilities" close by, and the fact that 85 to 90 percent of patients would be self-referred by HFA physicians, declared the investment "inappropriate."

It ordered Hennepin Faculty Associates to get approval from the department before making any other major spending decisions for five years.

Overload or consolidation?

Investors in the new center say they're part of the solution, not the problem.

"The reason we participate in this project is this allows multiple groups to share the scanners rather than all owning their own," said O'Neill of Minnesota Orthopedic Specialists. "This reduces the redundancy."

He said his group will sell its current one MRI and one CT scanner located less than 4 miles away at Vernon Avenue and Hwy. 100. "The goal is not to increase capacity," he said, adding that the group will also be moving into the same building as the new imaging center in October.

Suburban Radiologic Consultants will also be closing its current Suburban Imaging center in the Centennial Lakes Building on France Avenue, said Robert Starosta, vice president of business development.

Of the other physician groups that own their own imaging equipment, some will be selling them while others will continue to provide the services in their offices, Starosta said.

He declined to name the other medical groups involved, saying the doctors wanted to tell their patients first. Some of the groups are already in the building, he said, while others are looking to move in.

Fairview, which has a 20 to 25 percent stake in the venture, has long had relationships with a number of the medical groups involved, said Mark Domalewski, vice president of operations at Fairview Southdale Hospital. The hospital has two MRI and two CT scanners of its own and is on the block next to the new imaging center.

"We are not adding, but consolidating assets," said Domalewski, adding that the hospital has canceled plans to buy a new PET/CT scanner.

Chen May Yee • 612-673-7434

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