March 2013 – Issue 4
New 2013 Measures Released
Blue Cross and Blue Shield of Michigan
Physician Group Incentive Program
Colorectal Cancer Screening
Chlamydia Screening
Prenatal and Postpartum Care Screening
Diabetic Retinal Eye Exam
Is Radiology Really Necessary for
Low Back Pain?
Low back pain (LBP) is the 5th most common
reason for patients to see a provider.
According to the Institute for Clinical
Systems Improvement (ICSI), LBP accounts
for 26 billion in medical costs. In the U.S. it
effects up to 80% of the working population
during their lifetime. Many insurance payers,
physician organizations, and quality
improvement institutions are targeting LBP
because of the limited and inconsistent
patient outcomes despite rising treatment
spending. Michigan Quality Improvement
Consortium Guideline (MQIC) recently
updated their evidence based guidelines
which recommends diagnostic radiological
studies only if potential serious pathology is
revealed. These conditions deemed (RED
FLAGS) from MQIC are Cauda Equina (severe
or progressive neurological deficit), cancer,
fracture, infection, history of active TB,
anticoagulation or recent instrumentation.
Imaging studies should only be utilized if
RED FLAGS are present or if there is no
improvement after 6 weeks. Research
studies have revealed that 90% of LBP
episodes resolve within 6 weeks regardless
of treatment. The recommendations for
avoiding bed rest, staying active and
returning to work early are all associated
with less disability. Referral to Physiatry, or
manual therapy, should be considered before
surgery. Non-invasive therapy for improving
flexibility and strength is recommended but
not modalities such as heat, traction,
ultrasound, or TENS. The medication
strategies recommended are prescribing
medications on a time-contingent basis and
not pain-contingent basis. Early opiate use
may be associated with longer disability and
are not generally indicated as first-line in
treatment; however, if prescribed, the use
should be limited to a short period of time.
Diagnostic testing or imaging is usually not
required. ICSI had an advisory committee
work on improving LBP care, using the Triple
Aim as a guiding force, and incorporated the
ICSI’s Adult Acute and Subacute Low Back
Pain Guideline as an evidence-based
foundation.
References and further resources:
ICSI: https://www.icsi.org/
MQIC guidelines: www.mqic.org
MQIC Low Back Pain:
http://mqic.org/pdf/mqic_management_of_a
cute_low_back_pain_cpg.pdf
Related Article:
http://www.putmebacktogether.com/Deskto
pModules/EngagePublish/printerfriendly.aspx
?itemId=261&PortalId=0&TabId=134
A Small Glimpse at The Big Picture - Our
PGIP Radiology Utilization For Low Back
Pain
Our Blue Cross and Blue Shield of Michigan
(BCBSM) Physician Group Incentive Program
add space(PGIP) radiology utilization with
the diagnosis of low back pain yielded some
very startling results for the second quarter
2012 report. In PGIP, our providers
performed over 9,000 radiological imaging
studies (both high tech and low tech) at the
cost of over 2.5 million dollars. Remember
this is only BCBSM member population and
does not include any other payer or nonpayer data. If we take a conservable
approach and multiplied this number by each
insurance payer, our costs for LBP imaging
could reach more than $10 million dollars for
imaging that may not be recommended. The
Institute for Healthcare Improvement (IHI)
encourages organizations to focus on
population health, patient experience, and
per capita cost, known as the Triple AIM.
We (as an organization) can align with the
Triple AIM by following evidence based
research when ordering diagnostic
radiological imaging. This will assist in
decreasing the overutilization of imaging,
cost of services, and inappropriate radiation
exposure to the patient.
What Is Choosing Wisely®
The Choosing Wisely® Campaign is a great
educational resource tool for both the
patients and the providers. American Board
of Internal Medicine (ABIM) Foundation
Forum met in 2012 to examine innovations
that are changing health care for the better
by: improving the quality of care delivered;
increasing its responsiveness to patients;
and eliminating waste to lower the cost of
care. The Choosing Wisely® campaign is a
partnership that includes the ABIM
Foundation, Consumer Reports, and more
than 25 specialty societies that identifies
tests and procedures that are used too
frequently, has helped drive media,
physicians and the public to the risks
associated with overuse and the need for
provider–patient conversations about
appropriate care decisions. The “Five Things
Physicians and Patients Should Question” is a
colorized educational tool that provides a
statement about a certain test or procedure
which is highlighted in a particular color with
the recommended evidence based source
found on the next page in the exact same
color. The other Choosing Wisely®
document is a subject focused document.
“Imaging tests for lower-back pain. When
you need them – and when you don’t” is a
great tool to use for patients presenting to
the office with an acute episode of low back
pain. This document also provides the
valuable section titled, “Consumer Reports
Advice on the how should you treat lowerback pain?” These forms are not just to be
handed to the patients. This educational tool
is to prompt discussion and active dialog
with the patient and the provider; it is not to
be used as a substitute to seeking medical
treatment. BCBSM – PGIP encourage the
use of these products from the Choosing
Wisely® campaign. Special permission is
granted to organizations in the Consumer
Reports health communication program to
disseminate free copies of this report in print
or digital (PDF) formats to individual
members and employees. To obtain these
tools and resources visit:
Consumer Health Choices:
www.ConsumerHealthChoices.org