Some good stuff from Dr. Wes today. First, his thoughts on the (soon to be) routine triage test in ERs, the multidetector CT scan. Who pays for this? Well, if you’re an ER doc, it really doesn’t matter. 100% sensitivity offers pretty good lawsuit protection at any cost:
The (multi-)million dollar question is this: who will pay for this scanning? Sure the patient with an uncertain chest pain diagnosis might be able to find out their fate more quickly, but broad scale use of these scans will be VERY expensive for our health care system.There is significant pressure by government agencies to limit CT scan imaging in ER’s. And as we’ve seen, if these scans aren’t reimbursed, few people are likely to receive them.
Also, his thoughts on Pfizer’s hope-for blockbuster HDL-raising drug, torcetrapib.
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This test will only be useful to rule out ACS, not to rule in ACS or MI. And many technical factors have not been mentioned. Patients need to be adequately beta-blocked with heart rates approaching 60 in order for the scan to be useful.
And although the imaging itself takes only a few seconds, the processing of the data, 3-d reconstruction and interpretation take considerably longer.
I suspect that this will not be as useful as many are hoping.
“There is significant pressure by government agencies to limit CT scan imaging in ER’s.”
There is? I’m an ER doc, and I scan almost every patient that comes through the doors, for one defensive reason or other, most of the time just to cover my ass. No government agency ever pressured me. If they wanted to decrease the scans they should make the lawyers decrease their butt ramming.
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