Claims for 2008 were the most recent forms available, but those who’ve seen the numbers believe the practice has gone unchecked. According to the Times:
In 2008, about 75,000 patients received double scans, one using iodine contrast to check blood flow, and one that did not.
Some hospitals were doing this 80% of the time for their chest patients. Medicare officials and radiologists agree that that’s way too high, as the need for performing that kind of double procedure—such as for detecting elusive tumors—is rare at best. Rates as high as even 30% are considered unacceptably high, especially when the national average is 5.4%. What’s more, Medicare paid out $US25 million to hospitals doing double scans.
The reason behind the practice is murky, though, as it doesn’t fall so neatly into the “hospitals need money” category. One theory is the differing opinions among physicians regarding the kinds of care their patients need. Some facilities, particularly in small rural communities, might perform the two tests as a means of evaluating their patients quickly and efficiently. Double scanning is also popular among younger, privately insured patients.
Ultimately, it becomes a matter of changing doctors’ opinions about when such tests should be administered. That kind of debate takes time. [NYT, Image Credit: Li Wa/Shutterstock]
Ross
Monday, June 20, 2011 at 3:09 PMYou doubt that, “hospitals need money”?
I’ve got friends in Hospital management, they are always cutting costs to increase beds/nurses/doctors to cope with increasing demand..
reality is healthcare costs! But I’d rather that then America’s system!
Rahux
Monday, June 20, 2011 at 5:40 PMLuckily this ‘double scan’ business (CT & CTPA) pretty very rarely happens in Australia but even a CTPA alone is about 900 chest X-rays worth of radiation. It’s a difficult call to make though.
They are required to rule out clots in the lungs which can be fatal and are treatable. So the benefits of finding one is high. The issue with America is that their high litigation rate means that their doctors want to do more scans ‘just to be safe’ in case they get sued for missing one. The legal culture here is a little less toxic so doctors are more likely to do try to minimise risk to the patient and not just to themselves.
Steve
Monday, June 20, 2011 at 9:12 PMIt’s a problem due to the HMO system, not because the radiographers or doctors or bad, or the equipment is faulty.
RL
Tuesday, June 21, 2011 at 12:06 AMOh wow
see, I’m a radiographer, and when I find stories like this, I’m inclined to facepalm.
Firstly, this is AMAERICAN medicare- look at the source, its new york times.
In Australia, we do not bill double for these scans. We have one billing code for contrast procedures, one for without contrast procedures. The one WITH contrast costs a little bit more- since we need to PAY for iodine contrast (duh!)
SECONDLY, a CT scan pre and post contrast is REQUIRED, as are some in different phases of contrast dissemination- portal venous phase, arterial phase, etc etc). Yes, I AM a radiographer. If contrast is needed, radiologists ask for it. If contrast is definitely not needed, the FIRST scan is done to determine whether contrast is indicated. And then the referring doctor is consulted.
Bottom line is- radiologists need to see how well a lesion is vascularised, what it’s made of, how far it extends, and if it’s metastasized anywhere else
Oh and thirdly- this is done all the time in Australia. You cannot just scan somebody once after contrast injection, it does NOT work that way.