Jaime Toro, MD reviewing Burke JF et al. Neurology 2016 Jul 8.

A retrospective study documents overuse of neuroimaging in patients with headache and neuropathy both in Medicare and the VA system, but more so in Medicare.

The quality of care in the Veterans Affairs (VA) healthcare system improved significantly during the period from 1997 through 2000 and was significantly better than that in the Medicare fee-for-service program (N Engl J Med 2003; 348:2218). The aim of the Choosing Wisely campaign is to encourage medical specialty societies to develop lists of recommendations for tests that are overused or misused. To that end, researchers retrospectively compared neuroimaging appropriateness for headache and for peripheral neuropathy in a large Medicare cohort and in a VA cohort from 2004 to 2011. Inclusion criteria were age over 65 years and an outpatient visit for incident neuropathy or primary headache. The VA cohort included 93,755 services for headache and 183,642 for neuropathy; the Medicare cohort included 1244 services for headache and 998 for neuropathy.

Inappropriate imaging for headache and peripheral neuropathy was more common in the Medicare cohort compared with the VA cohort. Neuroimaging was performed in 49% of all headache patients in the Medicare cohort compared with 22.1% in the VA cohort. A total of 23.7% of patients with neuropathy in the Medicare cohort received neuroimaging compared with 9.0% in the VA cohort.

CITATION(S):

Burke JF et al. Neuroimaging overuse is more common in Medicare compared with the VA. Neurology 2016 Jul 8; [e-pub].

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