How CTs and MRIs drive health care spending

It’s well known that the use of imaging scans, like CTs, MRIs and PET scans, have been growing at an alarming rate.

But a recent study provides some stark numbers.

According to a recent CDC report, “MRI, CT or PET scans were done or ordered in 14 percent of ER visits in 2007, the report from the Centers for Disease Control and Prevention found. That’s four times as often as in 1996.”

Although a physician called that growth “astounding,” it’s really no surprise.

Emergency departments are becoming more crowded, and with patient satisfaction scores becoming more influential in financial incentives for physicians, sometimes just ordering a test is the path of least resistance.

Factor in the specter of defensive medicine, which, according to a survey from the Massachusetts Medical Society, accounts for up to 28% of tests ordered, it’s a wonder that more scans weren’t ordered.

Imaging scans are clear cost driver in health care, contributing $12 billion to Medicare’s bill. But costs won’t resonate with patients requesting the tests, or the doctors ordering them. One encouraging sign is the recent trend of publicizing the harms of scans, like radiation from CTs. I’m finding that patients are becoming increasingly aware of the risk, and making a more informed decision after I explain it to them.

It’s a small step forward.

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  • Vernon Rowe, MD

    We need to be more careful when pointing to a particular area of health care to target as a culprit in rising medical costs. This article, along with a recent article in the Boston Globe headlined “Pricey Imaging Pushes Up Heath Costs”, makes imaging costs look evil – but one has to look deep within that story to unveil an interesting nugget truth of which the general public is unaware and that current health reform ideas are not addressing.
    “Blue Cross Blue Shield of Massachusetts, the state’s largest insurer, said that in 2006, 40 percent of the MRIs it paid for were done at hospitals, compared with 50 percent by 2008. That has significant cost implications, said Andrew Dreyfus, executive vice president for health care services, because the insurer pays an average $700 for an MRI in a freestanding clinic, but twice that much at a hospital.” Entire article
    The fact that hospitals charge much more for everything they do compared with outpatient centers is just the tip of the iceberg of waste in our current hospital-based healthcare system. I wrote more on this previously in a post titled Massachusetts Healthcare – Not Miracle, but Smoke and Mirrors.

    It is ironic that in the state that is touted as the first experiment in universal health care, that hospitals are identified as driving up the cost of care while at the same time Boston Medical Center is suing the state of Massachusetts for non-payment of services. Leading expert on the use of MRI, Dr. Michael Hutchinson of NYU estimates the cost of outpatient MRI to be less the 1/2 of 1 percent of total healthcare expeditures. MRI use in the outpatient setting, that identifies a patient problem and sets a proper course of therapy can be the most cost-effective tool in patient care. Let’s be careful as we point fingers at imaging that we don’t demonize the finest tool (MRI) that medicine has given us in decades.

  • radiculous

    File under defensive medicine: In the ER, get a CT whenever possible, have the telerad read it, and you won’t be responsible for interpreting plain films (eg: t-spine, c-spine, l-spine CTs for ER patients with chronic pain–probably 10x as expensive as plain films; it happens all of the time)

  • WhiteCoat

    Radiculous –

    … so the teleradiologist can give us a “preliminary reading” (because their computer screens must be so inferior to those at the hospital) and then the hospital radiologist can call us with some important clinical finding the next morning after the patient has been discharged, recommending three other diagnostic radiology tests to confirm said condition. “It happens all of the time.”

    Not so much fun when people make BS overbroad generalizations about your specialty, is it?

    By the way, perhaps you could educate everyone on the proper criteria for obtaining plain films versus CT scans in someone with “chronic pain” who suffers an injury. Love to use your comments in a future post.

  • Dr.Nick

    How about the bogus pricing of scans? If they run the machine 24/7 they amortize the capital costs pretty damn quick. When they continue to receive the same reimbursement for years afterwards they’re in pure profit- cost of their staffing of course.

  • radiculous

    First of all, whitecoat, you are not really responding to what I said about defensive medicine. Secondly, I said nothing about an injury, which should get at least an x-ray. I said “chronic pain.” Should that get the million dollar work-up in the ER? Also, Dr Nick, how many radiologists actually own the scanners in the hospital? Zero. Therefore all your BS about amortization etc makes no sense.

  • SarahW

    Open pricing and MSA’s will drive down the cost of MRI’s and CT’s. When this nation gets serious about health care reform (and I don’t mean the legistlation in progress which ought to be, and I think will be, scrapped at some point)
    transparency of cost and consumer power restored to the end user of services will make a huge difference.

  • WhiteCoat

    Perhaps ordering extra studies does constitute defensive medicine. Don’t berate others for engaging in it when you and the docs in your specialty do the same thing.
    You still haven’t given me the criteria for “chronic pain” patients that don’t require CT scans or MRIs from the emergency department.

  • WhiteCoat

    Still waiting …

  • Pat Jonas, MD

    One strategy to balance CT use is to make the patient sign a consent form to agree to the study. When they read the part about cancer risks for the future in bold print, they will have a better chance of clarifying their need for the study to be done. In any other area of medicine, a patient would have to sign a consent to incur the risk equivalent of a CT scan. Patients deserve a chance to say yes to the scan, or no to the scan.

  • samrey

    its the combinations of health care services, from hospitals, drug companies, medical devices, insurance companies, lawyers, lawmakers, authorities who approves fee schedules and re imbursements for all these are all major causes of the outrageous rise in health care cost. EXCEPT the majority of md pcp and specialists whose fees re imbursements for their services have not gone beyond the cost of living inflation, while all others have hit the ceiling. Proper and rational distribution of medicare and other federal state health care moneys, which is really BIG money should be more than enought to cover everyone. not even counting on cleaning all the waste and innefficiencies that goes with all these.

  • SDRinc, MD

    transparency law as declared by our President OBAMA, bless his heart, lately….make it stick.

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