CT scans

The LA Times (via the WSJ Health Blog) on the downsides of the exploding use of CT scans.

The risk of cancer is discussed, which should give patients pause before undergoing the scan. It’s a good sign that the media is taking a more critical look at overtesting.

Medicare has attempted to limit the number of scans but decreasing payment. However, the results of such a superficial solution is predictable:

So far, the government’s most significant response to the scanning boom has been to reduce the reimbursements for a variety of medical scans, including CTs.
Undeterred, doctors simply ordered more scans.

Of course, the persistent ~~left-wing~~ media attack on doctors continues by focusing on physician-owned scanners.

The article barely mentions patient demand – which is a far more significant driver for the number of scans. It is very difficult to convince the public to reject CT scans, simply because the belief that scanning for disease “just in case” is too strong:

Ali Nader, a 46-year-old attorney in Beverly Hills, didn’t have any symptoms of heart trouble, but at a funeral for yet another relative who died of a heart attack, a cousin told him about a new type of scanner that could see into his coronary arteries.
He and his brother decided to visit Madyoon in June for scans. The total bill was $3,000 — a $500 discount. Their arteries were fine.
“I have more peace of mind than before,” Nader said.
He plans to repeat the scan once a year just to make sure.

Comments

Dr. Matthew Mintz
I agree patient demand is a big driver, but malpractice is an even bigger one. Even if a physician can convince a patient that the risk of irradiation is not outweighed by the very small chance that something “might turn up,” there is always the attorney who is ready to sue the very few times prudent clinical judgement turns out to be wrong. Even clinical guidelines can’t protect physicians since both side have expert witnesses stating the test should or shouldn’t have been done. In addition to educating patients, we have to change the malpractice system.
Maureen Zilly
I think that the Los Angeles Times story “CT scans can be better medicine for doctors than for patients” portrays an inaccurate picture of how physicians use computed tomography to care for their patients.
To begin with, the piece overstates the growth and utilization of CT. For example, the story uses GAO statistics to demonstrate an increase in CT scans, but the GAO's recent report on medical imaging did not account for the most recent data available. Had the GAO used the more current 2007 Medicare claims instead, its report would have actually shown a decrease in the growth of medical imaging services in recent years.
Next, the story presents biased information as fact. Insurance companies are wholly motivated to pay less for health care services, which includes limiting medical imaging scans. In fact, insurers have created a cottage industry, called Radiology Benefit Managers, with the sole purpose of refusing coverage for scans. By citing subjective and unverified insurance company-generated analysis of how many scans are "inappropriate," readers are presented with a skewed view about how and why physicians order scans.
Clearly, CT has grown as it's become integral to modern day medicine. From best practices to patient advocate guidelines, CT is a powerful tool for improving patient outcomes. But, the larger issue is ensuring patients have access to the right scan at the right time. In computed tomography this is even more important because of the radiation CT employs to generate what are often life-saving images.
That's why it is vital for payers — both private and Medicare — to ensure that healthcare decision making remains between the physician and patient. The recent Medicare bill is an important step in the right direction because it embraces both accreditation and appropriateness criteria, and it is approaches such as these that will ensure that each scan ordered is appropriate, effective and safe for patients.
Lastly, the article also claims that CT angiograms (CTA) are "less accurate" than traditional angiograms, but research has indicated otherwise. A recent study published in the Journal of the American College of Cardiology, for instance, found that CTA was 99 percent as effective in ruling out heart disease as the more expensive and invasive coronary angiography traditionally used by physicians. This CTA study is just one of many peer-reviewed data points demonstrating how medical imaging, and CT specifically, improves health outcomes and reduces overall costs.
Maureen Zilly
Medical Imaging & Technology Alliance

CT scans

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