Medical imaging is one of the largest drivers of health care spending.
In a recent NY Times piece, Gina Kolata points to the fact 20 to 50 percent of scans ordered are not necessary. Indeed, as health reformers like to point out vis-a-vis the Dartmouth Atlas study, more care isn’t necessarily better.
In fact, it can lead to worse outcomes, as these scans can point to findings that necessitate biopsies, or other invasive procedures, that can expose patients to additional medical risk.
A new problem, however, is coming to light. Apparently, scans performed on machines that are 10 years old are paid the same as those done on newer machines, often with significant differences in the result.
Regulating scans by forcing centers to be accredited isn’t likely to help, as “there is no consensus on objective measures to ensure quality,” and that, “there is still little assurance that scans will be appropriately ordered and interpreted or that a scanner will be up to date.”
So, in addition to the known variance in the delivery of care, we have the added fact that many imaging scans are done on machines that may be out-of-date. I’m not sure what patients can do about it, except to ask if the scans being ordered are being done on new machines.
Better still, patients can question whether the scans are really necessary in the first place, and perhaps, they can buy into the mindset that more tests do not always lead to better care.
We can only hope.
Related posts:
- CT scans will go on
- Why too many CT and MRI scans can be dangerous for patients
- Too many CT scans?
- Do physician quality measures tell patients who’s a good doctor?
- How following hospital quality measures can kill patients
- Cardiac scans are being overused
- CT scans and the ER
{ 3 comments }
Once again, the Devil’s in the details. While aging equipment is a problem, marked declines in reimbursement plus tightening of the credit market force centers with a Hobson’s choice – close or delay new purchases and soldier on. Without funding sources, demands for new equipment are unrealistic.
As far as unnecessary testing, there’s no argument this occurs. However, the problem will continue until the powers that be are ready to face the reality of defensive medicine and enact meaningful reform to rein in the voracious trial bar.
This only touches on the problem with scans. My pediatric hospital is a level 1 trauma center, so we get transfers from outside facilities all day. But a quarter of the time patients come without the actual scan, just a report. Unless it’s a slow day (rarely), we have to repeat the scan because it takes hours (sometimes days) to get the scan sent from outside. Insurance will not cover a second scan so shortly, so we swallow the cost. And sometimes the quality of the scan is crap, so we have to repeat the scan then too. Or the disk just doesn’t open on our computers (maybe they saved it in Mac OS5). There should be a mechanism that if the outside facility does not provide adequate imaging, we get paid for the scan we have to do and they should take the shaft. We don’t like to irradiate kids twice, but too many facilities (and it’s usually the same ones) force the situation because we have nothing useful to work with.
Somewhat related: Patient gets unneeded scan (like for a new isolated sixth nerve palsy in an older hypertensive), then refers. Rarely would you be wrong to wait 6weeks without a scan.
OR, a scan is ordered, but the area in question is not adequately imaged because the ordering Dr or the technologist or radiologist did not know better or think of it. Very common in my practice.
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