Sunday, June 19, 2011

Stop Unnecessary Medicare Tests

We are in a time when  Medicare is bankrupt and the GOP wants to privatize it and make seniors go to the open market to get insurance. Even the idea that we would dismantle this important social benefit is shocking yet everyone knows we have to bring costs under control.  So now we find that hundreds of hospitals (and radiologists)  in the United States are performing unnecessary CT scans on both Medicare and privately insured patients.

Not only is there an exposure to radiation when a patient undergoes a CT scan, the New York Times reports some hospitals were performing double scans over 80% of the time on patients.  It is rare that there should ever be 2 scans performed in succession.  Not only is the patient receiving twice the radiation, but Medicare is paying twice for an expensive test. (payment goes twice to both the hospital and to the radiologist separately).  Double CT scans are equal to about 700 standard chest X-rays.  That is truly excessive radiation unless it is absolutely necessary for diagnosis and treatment.

Before doctors start shouting that these double scans are necessary to make a diagnosis one must look at the extreme variation.  Some academic hospitals never do double scans while a community hospital in West Michigan gave two scans to 89% of its patients.  That variation in practice cannot be justified.

It is time to get serious about why such abuses in cost and quality are occurring.  We have created a system where there is a huge incentive to over treat and over prescribe.  From too frequent colonoscopys to MRIs to prostate biopsies, back surgery and thousands of other procedures - we reinforce overuse by paying more for doing more.  There is zero incentive for doctors or hospitals to stop doing more and in fact, those hospitals and radiologists who justify double CT scans on patients are  handsomely rewarded.  When you add in the fear of a lawsuit in case a rarity is "missed", it is surprising there are not more double scans being done. 

It is going to take us a while to climb out of this mess we have created called "American Health Care".  There are too many stakeholders that like the status quo and will go down fighting when change is proposed. 

The American Medical Association (AMA)  is still having debates about the mandate in health reform that  says Americans purchase an insurance plan.  Those opposed to a mandate believe a federal mandate "will undermine the innovations and improvements in  health care financing that can evolve in a free market."

Yes...a free market that pays handsomely for double CT scans.


Peggy said...

A an only child of two parents that each passed away at age 79, I can attest that there are way too many unnecessary tests, and if you question them you had better be fierce and have a thick skin. Many doctors seem to have no idea how much anything, including drugs, costs both in money and quality of life. I will go as far as to say they actively avoid knowing.

The pitched fit over the phone when I cancelled my mother's skin cancer check because she was in hospice for COPD still makes me shake my head.

theYogadr said...

Thanks for the call to action. We definitely have an American healthcare mess, and each individual practitioner ordering fewer unnecessary tests will help.

When I was working in the ER, I found that few patients realized there was any risk of cancer from CT scans. An explanation of the down side of testing helped. There's a misconception out there that more tests are always better, that tests always give the "right" answer, and that there's no downside.

Toni Brayer, MD said...

Peggy and Yogadr:
Thanks for insightful comments. We have run amuck with technology that doesn't bring value to patient care,quality or outcomes.

Anonymous said...

I work with a fella who was a doctor in Russia, and is now an EMT over here. The thing (leaving out the lawsuits that might drive a lot of the behavior) that he mentions is that doctors over here tend to be taught how to deal with certain symptoms but... I'm having trouble putting my thoughts into words. Essentially that most things over here are protocol driven, when no two patients are exactly alike. I guess I wonder if a number of the tests done are because student doctors are being taught that, for instance, if you see something, you have to biopsy it (all of this is for instance, of course). I dunno...