Concerns About Neurodiagnostic Studies

At the 2015 Harbor Health MPN Medical Director meeting, Dr. John Robinton from One-Call discussed concerns around the use of neurodiagnostic studies. This focused on the use of nerve conduction studies and EMGs.

EMGs and nerve conduction studies can provide information about the site of the pathology, the causal relationship to work, and the severity of the pathology. One main concern around these studies is the fact they are often over used by medical providers. Some of the other concerns include:

Who does the studies?

• There are credentialing organizations for someone to be board certified to conduct EMGs and to establish an accredited laboratory for the testing. Unfortunately less than one-in-seventy physicians conducting these studies is actually board-certified in EMG by the American Board of Emergency Medicine (ABEM), board-certified in neurophysiology by the American Board of Psychiatry and Neurology (ABPN), and actually runs an EMG lab accredited by the American Association of Neuromuscular & Electrodiagnostic Medicine (AANEM). 

Are the results accurate?

• If the test is done correctly and administered properly, they are accurate. The problem is, these tests are frequently administered improperly, which leads to inaccurate results. That leads to decisions around medical treatment based on flawed information, so the injured worker ends up with improper care. Studies show that 40% of physicians performing EMGs are performing the studies below acceptable levels of accuracy. Also, some physicians feel the tests can provide false negative findings.

Is there awareness of potential problems with the testing?

• There is widespread misunderstanding about these studies and the risks associated with them. Few truly realize how often these tests are inaccurate, which puts patients at risk for inappropriate care including unnecessary surgery.  Some dismiss them outright because of the high degree of inaccuracy. However, when properly administered, these studies can be very valuable. The issue then becomes identifying physicians who are properly credentialed and who conduct these tests properly.

Do payers understand the true value of the service?

• Some payers dismiss these studies outright because of the high degree of inaccuracy. Others do not understand the inherent problems associated with conducting these studies improperly. Again, when done correctly, these studies can be very valuable. The issue becomes identifying physicians who are properly credentialed and who conduct these tests properly.