The Use of Imaging Studies for Low Back Pain

February 2021

According to the American College of Physicians, clinicians and patients should select non-pharmacologic treatments such as superficial heat, massage, and acupuncture and nonsteroidal anti-inflammatory drugs or skeletal muscle relaxants for patients presenting with new symptoms of low back pain.

The Use of Imaging Studies for Low Pain is a HEDIS measure defined as “the percentage of adults age 18-50 who were newly diagnosed with low back pain and did not have an imaging study (x-ray, MRI, CT scan) within 28 days of the diagnosis.” The measure is used to indicate whether imaging studies are overused in the evaluation of members presenting with low back pain. Unnecessary or routine imaging is not associated with improved patient outcomes and exposes patients to unnecessary harms such as radiation exposure and further unnecessary treatment.  Patients may be excluded from the measure denominator for the following diagnoses: cancer; recent trauma; intravenous drug abuse; neurological impairment; HIV; spinal infection; major organ transplant; and prolonged use of corticosteroids.

Neighborhood’s 2019 Use of Imaging Studies for Low Back Pain rate stood at 70.42% and ranked in the Medicaid Quality Compass (QC) 10th percentile. The QC 90th percentile for Medicaid plans in 2019 was 81.96%. This measure represents an opportunity for improvement in patient care both for the plan and for treating physicians in our network.

How can you help?

  • Unless one of the reasons for exclusion listed above is present, consider alternative treatment options prior to ordering diagnostic imaging studies, such as the following: heat, massage, physical therapy and exercise to strengthen the core and lower back.
  • Educate patients on the potential danger of radiation exposure.
  • Obtain a “low back pain” assessment before recommending imaging study, i.e., perform a physical examination and identify secondary causes of acute low back pain.
  • Be cautious and responsible in the use of opioids in the presence of acute or subacute low back pain. Whenever appropriate, use nonsteroidal anti-inflammatory drugs or skeletal muscle relaxants.

HEDIS® is a registered trademark of the National Committee for Quality Assurance (NCQA).