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.