MRI: On the Cusp of Renewed Greatness?

What’s going on with MRI? Once the darling of medical imaging, MRI had fallen on hard times. But those times didn’t last.

After years of growing popularity, MRI usage fell sharply from 2016 to the next year. Then, in 2018,MRI rebounded, according to the Organization for Economic Cooperation and Development (OECD). Whether that will continue this year and beyond is hard to say.

What we do know is that federal regulators have been targeting imaging – particularly the higher tech, more expensive modalities. Imaging reimbursements have been declining for years. But lately, the picture has been mixed.

Medicare rates held steady for hospital outpatient services throughout radiology in 2019 for hospitals and doctors,increasing by 1.35%就像他们在2018年那样。But a shift is underway to bundle outpatient services into what are calledAPCs(Ambulatory Payment Classifications).

与此同时，一些门诊MRI提供者正在降价。Smart MRI,for example, is advertising better pricing and, in a doff of the proverbial hat to the consumer, is advertising a “better patient experience,” as well.

The Power of Value

The decision by this chain of outpatient MRI centers aligns with value-driven medicine, which is advancing at the same time that providers, insurers – and, importantly, employers – have come to recognize that MRI delivers value. This could be very significant.

Companies – at least ones that look to the long term – recognize that MRI can help. Speaking at the annual meeting of the AHRA in July, an executive ofThe Advisory Board Company said: “We want our 25-year-old employee to get his MRI (when he hurts his back).” Better to treat that injury when it happens, he told me, rather than later on. “If he is our employee 25 years down the road, we don’t want to bear the cost of $50,000 for more advanced care,” he continued – certainly not when an MRI might have provided information that could have led to a resolution of the issue early on.

Gunslingers on the Rebound?

The Wild-West days of magnetic resonance imaging are gone. Those were in the 1980s, when outpatient MRI was roaring (largely because MR scanning was less expensive at clinics than in hospitals); and when the value of the modality was as evident as the images were startling. These times may be long ago but they may still be relevant.

One MRI convert told me back then that he had never seen anything like MR images. Now, decades later, just about everybody is familiar with MRI – doctors and nurses; parents and children; even sports fans who read about injured players’ knee scans.

With a slight twist, could history be repeating itself? Could MRI be in for a resurgence?

潜在的驱动力可能是对神经肌肉疾病诊断的需求——虽然尚未被证实，但作为一种直观的诊断辅助工具是有帮助的。以进行性肌肉退行性变和虚弱为特征，每种神经肌肉疾病都是罕见的。BUT…taken as a group,their incidenceis common.

Many lack effective treatment with drugs fully approved for marketing. Magnetic resonance imaging and spectroscopy are showing increasing promise as an outcome measure in clinical trials for these diseases.

If this potential leads to drugs for disease treatment, the use of MR imaging and spectroscopy for diagnosis might accompany the marketing of these drugs. And then there are recent developments in cardiac MR, particularly as it relates toFFR(fractional flow reserve).

But even if such developments don’t drive MRI growth, the modality could be in for a growth spurt through the widespread adoption of value-medicine. Already we are seeing a lot of work being done on the underlying technology.

Future Products – Or Not?

Works in progress run the gamut from whole MRI systems to components designed to improve workflow. Some promise to bring data to mobile devices, such as cell phones and tablets. The question is whether these new ideas will turn into real products or if they are just hopeful embellishments of where technology might go. A lot is at stake.

核磁共振设备的制造商必须预测市场的走向，就像四分卫必须投向接球手的方向，而不是投向他曾经去过的地方。但他们必须小心。他们都可以被头饰欺骗。

For-profit companies eventually have to make a profit. And making the world a better place is not their top criterion. That is not to say profitable businesses don’t make the world better. They did so when it came to MRI and other high- tech -- as well as low-tech -- imaging modalities. (When was the last time you heard of a doctor recommending exploratory surgery?)

但不可否认的是，成像技术使医疗保健变得更加昂贵。是的，像探查手术这样的英雄式措施，如果有的话，现在很少有人做了。但这种手术从来都不常见。这是有原因的。

探索性手术不仅对患者的身体来说难以承受，而且还增加了费用，占用了手术室和工作人员的时间，而且由于患者要住院数天或数周，还会产生成本。另一方面，MRI已经被广泛使用了，尤其是在美国，几十年了。

在20世纪80年代中期，医疗保险开始报销扫描费用。第三方保险公司也纷纷效仿。于是闸门打开了。

As often happens with any new technology, MRI reimbursements were high in those early days. Not surprisingly, the number of MRI scanners installed in the U.S. spiked n the following decades. But the number began to ebb as the market grew saturated and reimbursements declined. Still MRI remains popular.

In 2018,119 MRI exams根据经济合作与发展组织(OECD)的数据，美国是世界上第二大使用核磁共振成像的国家，仅次于德国。

Even though medical practice in the U.S. is changing, such that value – not reimbursement – is becoming the most important factor. But cost will remain an issue, because it will factor into the calculation of value.

And so, MRI has come to a fork in the road. It stands either on the cusp of renewed greatness or on the periphery of a bubble ready to burst. Or it could just stand there – paralyzed – at that fork.

时间——以及磁共振技术的发展——将会告诉我们答案。