Use of Imaging Studies for Low Back Pain

January 2022

The Use of Imaging Studies for Low Back Pain (LBP) 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.

According to the National Committee for Quality Assurance (NCQA), avoiding imaging for patients when there is no indication of an underlying condition can prevent unnecessary harm and unintended consequences to patients and can reduce health care costs.

Measure Exclusions:

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 Use of Imaging Studies for Low Back Pain measurement year (MY) 2020 rate increased to 76.64% and rated in the Medicaid Quality Compass® (QC) 50th percentile compared to MY 2019 rate of 70.42% and QC 10th percentile. Note that the rates show the percentage of patients receiving appropriate treatment, not those receiving potentially unnecessary imaging.  Thank you for your ongoing commitment to helping achieve the highest level of care possible for your patients.

Some Helpful Tips for Improving your Facility’s Rate on this Measure are the Following:

  • 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).

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