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Outpatients with low back pain who had an MRI without trying recommended treatments first, such as physical therapy

Description of Measure

An MRI (magnetic resonance imaging) is a test that uses a powerful magnetic field and a computer to produce detailed pictures of the inside of the body (bones, organs, and other body parts). Although MRI scans can be helpful for diagnosing low back pain, they can also be used too much. Low back pain can improve or go away within six weeks and an MRI may not be needed.

Why is this Important?

Standards of care say that most patients with low back pain should start with treatment such as physical therapy or chiropractic care, and have an MRI only if the treatment doesn’t help.

Finding out whether treatment helps or not before having an MRI can be a safe and effective way to avoid unnecessary stress, risk, or cost of doing an MRI.

  •  For patients with certain conditions, getting an MRI right away is appropriate care. Patients with these conditions are not included in this measure.
  • If you have low back pain, you, your doctor, and the medical imaging facility staff can talk about the best time to do an MRI if you need one.
  • Since MRIs use magnets rather than x-rays, there is no radiation risk. However, because the magnets attract some kinds of metal, it’s important for the technician to know if there are any metal objects or implants inside your body, such as pacemakers, artificial joints, screws, stents, plates, or staples. Metal objects can pose serious risk to you during the MRI and interfere with the test.
  • For some MRIs, a substance called “contrast” is injected before the test to make parts of the body stand out more clearly on the images. Risks of contrast include possible harm to the kidneys or allergic reactions. Contrast shouldn’t be used if it isn’t needed.
  • Having the test can be stressful for some people. Patients must hold still for about 15 to 45 minutes while lying on a table that moves inside a large scanning machine. While images are being taken, the machine makes loud noises.
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All descriptions and data sources are reported from Hospital Compare.

Data reported are based on discharges from Third Quarter 2012 through Second Quarter 2013

Outpatients who had a follow-up mammogram, ultrasound, or MRI of the breast within 45 days after a screening mammogram

Description of Measure

A screening mammogram is an x-ray of the breast to check for possible breast cancer before it can be detected by women or health care professionals.

Why is this Important?

Although mammography is a good test, it is not perfect. Some women who do not have breast cancer will have an abnormal mammogram (even though they are cancer free) and some women with breast cancer will have a normal screening mammogram (their cancer is missed).

Some women may be asked to come back for follow-up testing if there are signs of possible breast cancer. A follow-up visit usually means having more tests (mammograms, an ultrasound, or both). The numbers of women asked to follow-up varies widely among mammography facilities in the United States.

There are many reasons for differences in follow-up rates including poor technique (blurry X-rays that need to be repeated), a lack of skill or experience interpreting the screening mammograms, medical history of the woman undergoing screening, and whether a woman is being screened for the first time, or has previously undergone mammography screening.

The follow-up rates reported here for mammography facilities include follow-up exams performed on the same day as screening mammograms.

Medical evidence suggests that there may be a problem if a facility has either a very low or very high rate of follow-ups.

  • Although, values for a very low follow-up rate have not been established, a follow-up rate near zero may indicate a facility that misses signs of cancer. Follow up rates around 9% are typical.
  • Research has established that a follow-up rate above 14 percent is not appropriate and may indicate a facility doing unnecessary follow-up.

If you have a screening mammogram and you are called back for additional testing, ask your doctor why and what this additional testing means in your case for how he or she makes an accurate diagnosis.

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All descriptions and data sources are reported from Hospital Compare.

Data reported are based on discharges from Third Quarter 2012 through Second Quarter 2013

Outpatients who got cardiac imaging stress tests before low-risk outpatient surgery

Description of Measure

A cardiac stress test measures the heart’s ability to respond when it is stressed, and can be useful in evaluating a patient’s surgical risk. Experts agree, however, that these tests are not necessary before most low-risk outpatient surgical procedures, such as colonoscopies, cataract surgery, biopsies, or endoscopies (using “scopes” to look inside the body) because these procedures put very little stress on the heart.

Why is this Important?

This measure shows the percentage of all cardiac stress tests done in a hospital outpatient imaging department (using echocardiograms, CT scans, and MRIs) for Medicare patients who were going to have certain low-risk outpatient surgical procedures. Hospital outpatient imaging departments that have higher percentages on this measure may be giving people more tests than they need.

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All descriptions and data sources are reported from Hospital Compare.

Data reported are based on discharges from Third Quarter 2012 through Second Quarter 2013

Outpatient CT scans of the chest that were “combination” (double) scans

Description of Measure

A CT scan (also called a CAT scan) uses multiple x-rays to produce detailed pictures of the inside of the body (bones, organs, and other body parts). For some, a substance called “contrast” is put into the patient's body before the scan begins, to help make parts of the body stand out more clearly. Contrast can be either swallowed or injected into a vein.

“Combination” CT scan means that the patient gets two CT scans —one scan without contrast followed by a second scan with contrast.

Why is this Important?

Standards of quality care say that most patients who are getting a CT scan of the chest should be given a single CT scan rather than a “combination” CT scan. Although combination CT scans are appropriate for some parts of the body and some medical conditions, combination scans are usually not appropriate for the chest.

The range for these measures is from 0% to 100%. For hospitals with higher percentages, it may mean that the facility is routinely giving patients combination CT scans of the chest or abdomen when a single scan is all they need.

Giving patients two scans when they only need one needlessly doubles their exposure to radiation:

  • Radiation exposure from a single CT scan of the chest is about 350 times higher than for an ordinary chest x-ray. 
  • For combination CT scans, radiation exposure is 700 times higher than for a chest x-ray because the patient is given two scans. 
  • For a combination CT scan, radiation exposure is 22 times higher than for an x-ray of the abdomen because the patient is given two scans.
  • Radiation exposure from a single CT scan of the abdomen is about 11 times higher than for an ordinary x-ray of the abdomen.

When contrast is used, there are risks that can include possible harm to the kidneys or allergic reactions (especially if the contrast is injected). To avoid unnecessary risk, contrast should be used only when it is needed. If you need to have a CT scan of the chest or abdomen, feel free to ask your doctor these questions to determine what’s best for your medical condition:

  • Do you need a single scan - either with or without contrast - or is a combination scan necessary? •Is using contrast appropriate for your medical condition?
  • Although, values for a very low follow-up rate have not been established, a follow-up rate near zero may indicate a facility that misses signs of cancer. Follow up rates around 9% are typical.
  • Research has established that a follow-up rate above 14 percent is not appropriate and may indicate a facility doing unnecessary follow-up.

If you have a screening mammogram and you are called back for additional testing, ask your doctor why and what this additional testing means in your case for how he or she makes an accurate diagnosis.

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All descriptions and data sources are reported from Hospital Compare.

Data reported are based on discharges from Third Quarter 2012 through Second Quarter 2013

Outpatients with brain CT scans who got a sinus CT scan at the same time

Description of Measure

Brain CTs and sinus CTs can be important tools for diagnosing problems that may be causing severe headaches or chronic sinus infections, but they also expose patients to high levels of radiation. Brain CT scans cover large parts of the sinuses, so ordering both tests may be unnecessary. For patients with chronic sinusitis, a sinus CT is usually done first before deciding if a brain CT is also needed. Experts do not recommend doing both tests at once, unless patients have head injuries, tumors, or serious signs of infection. Hospital outpatient imaging departments that have higher percentages on this measure may be giving people more tests than they need, exposing them to too much radiation.

Why is this Important?

This measures shows the percentage of brain CT scans done in a hospital outpatient imaging department where a sinus CT scan was done at the same time on the same Medicare patient. It does not count cases where doctors had questions about complications due to injuries, cancer, or serious infections.

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All descriptions and data sources are reported from Hospital Compare.

Data reported are based on discharges from Third Quarter 2012 through Second Quarter 2013

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