MRI Utilization and the Associated Use of Sedation and Anesthesia in a Pediatric ACO.
OBJECTIVE
MRI is commonly used in the pediatric population and often requires sedation or general anesthesia to complete. This study used data from a pediatric accountable care organization (ACO) to investigate trends in MRI utilization and in the requirement for anesthesia to complete MRI examinations.


METHODS
The Partners for Kids (PFK) ACO claims database was queried for MRI examination encounters involving patients 0 to 18 years old from 2009 to 2014, with utilization expressed as encounters per 10,000 PFK members-months. Data were limited to 2011 to 2014 to ensure consistent billing of anesthesia services. Encounters were classified according to the presence of procedure codes for anesthesia or sedation.


RESULTS
MRI utilization was approximately constant over the study period at 11 to 12 encounters per 10,000 member-months. The need for anesthesia increased from 21% to 28% of encounters over 2011 to 2014. The latter increase was shared across 1- to 6-year-old, 7- to 12-year-old, and 12- to 18-year-old subgroups. In multivariable regression analysis of monthly utilization, increasing need for anesthesia could not be attributed to secular trends in patient demographics or types of examinations ordered. Paid cost data were available for outpatient MRIs, and MRIs with sedation accounted for an increasing share of these costs (from 22% in 2011 to 33% in 2014).


CONCLUSIONS
There was an increasing need for anesthesia services to complete MRI examinations in this pediatric population, resulting in increasing cost of MRI examinations and presenting a challenge to ACO cost containment.
Department of Anesthesiology and Pain Medicine, Nationwide Children's Hospital, Columbus, Ohio; Department of Anesthesiology and Pain Medicine, The Ohio State University College of Medicine, Columbus, Ohio. Electronic address: Joshua.Uffman@Nationwidechildrens.org.
Joshua C
JC
Uffman
Department of Anesthesiology and Pain Medicine, Nationwide Children's Hospital, Columbus, Ohio; Department of Pediatrics, The Ohio State University College of Medicine, Columbus, Ohio.
Dmitry
D
Tumin
Department of Anesthesiology and Pain Medicine, Nationwide Children's Hospital, Columbus, Ohio; Department of Anesthesiology and Pain Medicine, The Ohio State University College of Medicine, Columbus, Ohio.
Vidya
V
Raman
Department of Anesthesiology and Pain Medicine, Nationwide Children's Hospital, Columbus, Ohio; Department of Anesthesiology and Pain Medicine, The Ohio State University College of Medicine, Columbus, Ohio.
Arlyne
A
Thung
Department of Radiology, Nationwide Children's Hospital, Columbus, Ohio; Department of Radiology, The Ohio State University College of Medicine, Columbus, Ohio.
Brent
B
Adler
Department of Anesthesiology and Pain Medicine, Nationwide Children's Hospital, Columbus, Ohio; Department of Anesthesiology and Pain Medicine, The Ohio State University College of Medicine, Columbus, Ohio; Department of Pediatrics, The Ohio State University College of Medicine, Columbus, Ohio.
Joseph D
JD
Tobias
D060866:Accountable Care Organizations; D000768:Anesthesia, General / Q000706:statistics & numerical data*; D002648:Child; D003365:Costs and Cost Analysis; D016208:Databases, Factual / Q000706:statistics & numerical data; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000706:statistics & numerical data*
Accountable care organization (ACO); MRI; anesthesia; sedation; utilization