In a double CT scan, patients get two imaging tests consecutively: one without dye and the other with dye injected into their veins. Providence Hospital in Northeast Washington and nearly one of every six hospitals in Virginia were among those performing double scans particularly frequently, according to the most recently published government data, from 2008....Experts say almost all chest problems can be properly diagnosed with a single scan. But some physicians, who order the tests, still value double scans for gathering the most information possible. Hospitals and radiologists are paid more for the double scans, so they have a disincentive to crack down on them. ... The scans’ benefits are great. They allow physicians checking for cancer, heart disease, damage to arteries and blood clots to see inside the body with detailed, multi-dimensional pictures. But chest CT scans also expose patients to about 70 times more radiation than conventional X-rays. Having the combination CT scan can double that exposure, though some physicians say the latest generation of scanners operate with much lower radiation levels.
There are several points worth noting here:
1. Double scans are not scans done twice but two scans done with and without contrast to get better resolution. The process has merit in a very small number of complex cases.
2. The billing is such that there is effectively a double bill. This can be corrected since frankly it does not cost twice the amount.
3. The radiation issue is overwhelming. That should be the driver.
4. Scan this much and I guarantee you will find a batch of new issues to be concerned about.
5. In a hospital like the Brigham in Boston there is 0% whereas in suburban NJ hospitals it is 5-7%. Why? The Brigham has some of the best diagnosticians and radiologists in the world, and perhaps they know better. Or perhaps the Brigham has installed controls in the radiology department to prevent this type of putative patient abuse. I suggest it is a combination of both.
So how should Medicare handle this? Good question, is it better radiology EHR systems or via financial penalties. We will see.
Posts
