Medicare Claims Show Overuse for CT Scanning

I get them every year or so to monitor benign tumors on the liver and my doctor has stated on more than one occasion CT scans should be greatly limited, that they are dangerous. They will use ultrasound and MRI when they can. Amazing what they are doing to the people on Medicare/Medicaid.

Some clarification is necessary. The 2 scans they are talking about are unenhanced and enhanced CT (pre and post IV contrast). These are 2 phases of the same study, not merely 2 successive exams. Some people are confusing this with overutilization which is a huge, but different problem. This protocol is designed to answer specific questions. There was/is a school of thought that the enhancement characteristics of a nodule are useful in assessing its malignant potential, (you can't tell if something enhances if you don't have unenhanced images to compare with, hence 2 exams), and if felt to be "benign" by CT, a biopsy (and all the expense and morbidity that go along with it) could be avoided. The unenhanced/enhanced chest CT for nodule characterization isn't great, and in terms of non-invasive diagnosis has been largely supplanted by newer technology (PET and PET/CT).

Hospitals still using the pre-/post protocol routinely aren't doing it to get rich. They either still believe the enhancement characteristics are important, don't have ready access to more advanced technologies, or they are just behind the times and have not updated their scanning protocols.

Another point is that while it is generally true that chest CT performed both without and with IV contrast does give twice the radiation dose, it by no means generates twice the money, as seems to be the implication by some. It pays maybe 20% more, but it requires more time, more staff, more hardware wear-and-tear, IV placement, more risk, more professional time and of course the contrast material itself.

Don't confuse this article's lightly informed rant with the rampant overutiliztion of diagnostic testing which stems from the practice of defensive medicine, increasing patient expectations and self referral.

Thank you for your clarifying comments. I read the article again after reading your comments and I feel I understand the contents of the article better.

You are mistaken about primary care docs, they are not paid for referrals, procedures or prescriptions.

They are the least paid for visits and their income depends on how many visits a day they can churn through.

If some body comes in with a test or script in mind and won’t leave without it, the doc can choose to get behind for the rest of the day explaining, just give in, or seem to just make an arbitrary decision.

I don’t know how to fix the problem. In our town, we don,t have enough primary care docs. Young ones can’t make enough money to pay their loans and build a busines, well established docs are looking for a way out, and the older ones are retiring because it just isn’t very fun anymore.

You are mistaken about primary care docs, they are not paid for referrals, procedures or prescriptions.

They are the least paid for visits and their income depends on how many visits a day they can churn through.

If some body comes in with a test or script in mind and won’t leave without it, the doc can choose to get behind for the rest of the day explaining, just give in, or seem to just make an arbitrary decision.

I don’t know how to fix the problem. In our town, we don,t have enough primary care docs. Young ones can’t make enough money to pay their loans and build a busines, well established docs are looking for a way out, and the older ones are retiring because it just isn’t very fun anymore.