Improving Diagnosis and Reducing Costs
Quality care. Timely treatment. Reduced costs. This has become the triple crown of healthcare as our country tries to reign in expenses and improve the system. In fact, unnecessary tests, treatments and surgeries are some of the greatest drains on already limited resources. The trickle down expenses of a misdiagnosis not only costs the system, but can harm the patient as well.
Electrodiagnostic testing is used to test the function of muscles and nerves and has emerged as one of the most effective and efficient ways to help determine the cause of back or neck pain, numbness/tingling, and strength loss. According to the American Association of Neuromuscular & Electrodiagnostic Medicine (AANEM), a quality electrodiagnostic evaluation, performed by a properly trained physician, decreases the number of tests needed to reach a final diagnosis and ensures a quick and more accurate diagnosis. This means that the correct treatment can be provided in a timely manner, saving healthcare dollars.
In fact, a normal electrodiagnostic evaluation often eliminates the need for costly back or carpal tunnel surgery. A recent study published in the medical journal Spine examined an insurer’s rule that required consultation by a physical medicine and rehabilitation physician before non-urgent surgical consultation and how that affected surgery rates. The results showed a 12.1 percent decrease in total spine care costs and a 25.1 percent decrease in surgical costs overall, representing a net decrease of more than $14 million in healthcare costs in one year. Electrodiagnostic evaluation was one of the primary tools used by the physician in the study to determine the need for surgical intervention.
How It Works
Physicians specializing in electrodiagnostic medicine conduct tests to measure nerve and muscle function, and identify problems associated with the neuromuscular system. The two main tests are a needle electromyography study (EMG), which records the electrical activity of muscles and nerves, and a nerve conduction study (NCS), which uses an electrical current to measure the size and speed of the response of the nerves.
Normal muscles give off a certain size, shape and sound of electrical signal. Muscles that have a damaged nerve simply give off very different electrical signals. Therefore, analyzing the abnormal electrical signals in a patient’s muscles helps the doctor to locate the specific site, nature and extent of nerve damage, if any.
NCV testing is almost always done along with the EMG exam. This test evaluates nerves by measuring how fast the electrical impulse travels through them. Certain nerve diseases cause electrical signals to be transmitted more slowly than normal. Again, this test helps the doctor determine the site, nature and extent of any nerve damage.
Referring physicians typically request electrodiagnostic studies to identify causes of radiating pain, weakness, numbness, tingling, fatigue and muscle cramping. Study results can diagnose conditions ranging from carpal tunnel syndrome and sciatica to amyotrophic lateral sclerosis (ALS) and diabetic neuropathy.
After diagnosis, patients return to see their referring physician to begin focused treatment, which may include lifestyle modification, splinting, physical and occupational therapy, medications, injections, or in extreme cases, surgery.
What to Look For in an Electrodiagnostic Provider
Since electrodiagnostic evaluations have increased in popularity, it is important to look for the following qualifications in choosing a provider:
Accreditation — The AANEM has developed an Electrodiagnostic Laboratory Accreditation Program to identify and acknowledge electrodiagnostic laboratories for achieving and maintaining the highest level of quality, integrity, and patient safety. Accreditation is a voluntary, peer review process that assesses the expertise of the staff, evaluates the policies and procedures utilized, and ensures the safety of the laboratory and equipment to improve accuracy and reliability of the testing and the patient care being provided.
Training/Certification — To reduce the risk of misdiagnosis, only physicians trained in neuromuscular conditions should conduct an EMG. The AANEM recommends choosing a doctor who has completed additional training in electrodiagnostic (EDX) medicine, which teaches them to properly diagnose nerve and muscle disorders. The American Board of Electrodiagnostic Medicine (ABEM) certifies doctors who have completed extensive EDX training. A trained technologist can perform nerve conduction studies if under a doctor’s supervision.
Having the right diagnosis at the right time not only improves patient care and outcomes, it reduces healthcare costs for all of us, and electrodiagnostic studies have become an important piece of this healthcare puzzle.
About the Author
Colleen Zittel, MD is a physiatrist and electrodiagnostic medicine specialist with Jewett Orthopaedic Clinic. She can be reached at (407) 643-1329.