Posted on 06/18/2011 2:11:42 PM PDT by ransomnote
Long after questions were first raised about the overuse of powerful CT scans, hundreds of hospitals across the country needlessly exposed patients to radiation by scanning their chests twice on the same day, according to federal records and interviews with researchers.
Performing two scans in succession is rarely necessary, radiologists say, yet some hospitals were doing that more than 80 percent of the time for their Medicare chest patients, according to Medicare outpatient claims from 2008, the most recent year available. The rate is typically less than 1 percent, or in some cases zero, at major university teaching hospitals.
Next month, the Center for Medicare and Medicaid Services is expected to release figures for 2009, but according to people who have seen the numbers, the practice of double scanning chest patients has continued.
“When I saw the 2009 numbers, they were the same essentially, and I was disquieted by that,” said Dr. Michael J. Pentecost, a radiologist and Medicare consultant who also reviews claims for commercial clients.
(Excerpt) Read more at nytimes.com ...
"A single CT scan of the chest is equal to about 350 standard chest X-rays, so two scans are twice that amount. "
Fear-inspiring propaganda to allow the CMS to put much stricter rules in place on reimbursing CAT and PET scans.
I want people to get the scans they need, but 80% double scanning seems too high. If medically necessary - then fine with me. A local hospital had a Cesarian birth rate several times higher than the average because it was performing them on women receiving Medi-cal at excessive levels(whatever the public assistance name is given to the program for impoverished women). When it was exposed, along with other treatment extremes, the hospital came under review and eventually changed hands. But Cesarian’s are still given at the new hospital - but now only when advisable.
In my opinion, the whole vicious circle of blame between tort-claimants, health care administrations, and insurance companies has become greedy.
An extra cat scan pays for the time waiting for the government to pay up and reduces the risks of malpractice.
Think about it...
I have thought about it. Prior to posting.
Somebody’s gotta pay for those expensive machines....might as well be the taxpayer!
Try x-rays are over used too. Tear a rotator cuff, you have to have an x ray which shows nothing but bone. Then a shot in the shoulder, because the pain doesn’t go away, then you are sent for an MRI to determine what the damage really is, when they knew all along it was more than likely a rotator cuff tear, which will not show up on a x-ray. MRI should have been done first and saved the cost of the x-rays.
My friend went through that. Just wouldn’t give her an MRI but kept pointing to x-rays that show nothing.
Well, it depends on how you look at things. What if the cheap plain x-ray did show the cause. Think of all the MRI’s you saved from being done.
I am not, and would not ever try to justify bad medicine and overuse of testing. That said, I would like to know the reasons and circumstances in which this occurred, and what reasons the physicians involved gave.
Generally, a non-radiologist orders the test, and a radiologist evaluates the need, indication, and whether or not the test ordered will answer the question being asked. It's illegal for physicians to receive kick-backs for referrals, including referrals for testing or imaging. So, if the radiologist was a greedy and unethical person, the referring physician would still generally have to OK the additional imaging, and would have no reason to do so financially.
What I wonder is whether or not there are other imaging modalities readily available at the institutions that are doing multiple CT scans. If MRI is not readily available, perhaps the impetus to do CT scans with and without I.V. contrast is higher.
The above aside, the rates for multi-CT studies in some of these institutions seems very excessive, and the reasons for this should be made clear to rule out medicare abuse.
I will, however, reserve judgment until more details are available.
Sounds to me like they are over billing. Doubtful if the person actually got the scans.
My mother was a breast cancer patient and it metasticized into a brain tumor. She was on Meicare and was treated at our great cancer facility herefor years before she finally died.
She had a cat scan every 6 months. Never had one twice in the same day.
jeez....typos. Medicare
The Stark loophole allows non radiologists to have CT and other imaging equipment in their offices. Some of the not egregious casework self-referral comes from cardiologists ordering CTs on their own scanners, orthopedists ordering MRI on their own scanners and urologists ordering ultrasounds on their machines. Hopefully after these many studies are done a radiologist will read them but not always
I agree entirely. The data they are referring to, however, looks to be from hospitals and not private offices.
There are caveats to this that are concerning, however. For example, if the same test is done, even by the same person, in a hospital facility vs. a private facility, the renumeration to the hospital is significantly higher. This has the effect of being anti-private practice, and favors centralization of services under administrative bureaucracies at hospitals.
It’s true and it is happening all the time. I Happened to go down to the place where they scanned my dad. less than 24 hours latter I was in the Hospital and the nurse told me my dad was going down for another scan.
FOR WHAT I asked. No he is NOT going down I told them I said get the doctor on the phone I will tell him MYSELF!
Nobody fought me. Later another friend of mine ( IS IT just me or are most of these people they take MULTIPLE Cat scans on SENIOR CITIZENS who usually do not speak up for themselves!)
My senior citizen friend recieved 7 cat scans in less than a week.
DISGUSTING! FOLKS BEWARE WHEN YOU GO INTO THE HOSPITAL.
If you speak up they give you a stupid look like they are saying “ WHAT DO YOU KNOW YOU ARE NOT A DOCTOR!”
This story is absolutely true. I work with seniors and my cousin is a nurse. She is leaving nursing because she said they are WHICH she says is a reason for a DIALYSIS place on every corner. Some folks are damaged for life because of all the scans and become dialysis patients.
I could argue that the MRI is usually a waste of money.
Shoulder strains and rotator cuff tears look just the same on exam initially. The strain will get better with time, if healing is slow, a cortisone shot can be helpful. If you don’t get better over time and with a shot, a diagnostic arthroscope makes more sense than an MRI, they can take a look and fix it at the same time.
If your doc doesn’t give you at least a month to heal prior to ordering a scan, they haven’t given you enough time to recover from a simple strain. If the shoulder still isn’t moving in 3 months, you probably need a scope regardless of what the MRI shows.
MRI scans are over utilized a portion of it is unrealistic expectations on the part of patients, a portion of it is justifying treatment to insurance companies, and an even bigger portion is laziness on the part of physicians. In the good old days, the doctor would sit down and explain the injury and normal healing times and schedule multiple follow up appointments to ensure that progress is being made. Now many busy docs just order an MRI without considering whether it alters treatment or not. The patient leaves thinking they have received the best treatment because they have a very expensive test ordered when in fact, the doc is just scooting them out of the office.
Second to make sure changes/procedures/equipment are in place
More smoke from the 0Bammy short hose!
“I could argue that the MRI is usually a waste of money.”
We waste money because we reward primary care physicians for prescribing tests, not making people well. They need to be rewarded for results, not tests. The more tests and drugs they prescribe and more referrals they give to their specialist cronies the more money they make. Health care is not about making people well but making money for the players.
If you’ve ever had a problem you quickly understand that you receive little overall “Project Management” or advocacy from the primary care physician and from someone seriously interested in your recovery. They step aside while the other providers do their tests on their specialty. The incentives need changed. There is little oversight.
End of life care provides huge waste of money for procedures and tests but little incentive for palliative care that makes people feel good. The best care for someone terminal would be drugs (Morphine, marijuana, etc) that keep them high instead of the reality of facing expensive painful treatments or tests that will do nothing. Rarely do they give the patient this option.
BTW as a new Medicare recipient I just went through the shoulder routine you described. First three months of home care and home treatment (exercise, stretching with no results) internet self diagnosis and shoulder muscle atrophy noted before involving physician. My physician ordered an MRI right out of the gate. Diagnosis, arthritis, no serious tear. Offered me PT. No improvement started getting worse. After 4 + weeks cortisone shot. X-ray done to ascertain if any non-MRI resolved bone spurs. 6 more weeks of PT and it has finally started resolving.
I favor bigger co-pays so that the patient has a stake in treatment and a real desire for PT or other services. The patient needs a meaningful out of pocket payment for best treatment and to participate fully.
Basically the system has many institutions especially in big cities that rip it off that have influence in Congress. We need to give big rewards for whistle-blowers, and Medicare needs a major priority on uncovering fraud. Give 10 average citizens with common sense and no political ties a day and they could come up with real solutions. The politicians are bought and paid for....all of them.
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