Posted on 06/28/2008 8:09:11 PM PDT by neverdem
A group of cardiologists recently had a proposition for Dr. Andrew Rosenblatt, who runs a busy heart clinic in San Francisco: Would he join them in buying a CT scanner, a $1 million machine that produces detailed images of the heart?
The scanner would give Dr. Rosenblatt a new way to look inside patients’ arteries, enable his clinic to market itself as having the latest medical technology and provide extra revenue.
Although tempted, Dr. Rosenblatt was reluctant. CT scans, which are typically billed at $500 to $1,500, have never been proved in large medical studies to be better than older or cheaper tests. And they expose patients to large doses of radiation, equivalent to at least several hundred X-rays, creating a small but real cancer risk.
Dr. Rosenblatt worried that he and other doctors in his clinic would feel pressure to give scans to people who might not need them in order to pay for the equipment, which uses a series of X-rays to produce a composite picture of a beating heart.
“If you have ownership of the machine,” he later recalled, “you’re going to want to utilize the machine.” He said no to the offer.
And yet, more than 1,000 other cardiologists and hospitals have installed CT scanners like the one Dr. Rosenblatt turned down. Many are promoting heart scans to patients with radio, Internet and newspaper ads. Time magazine and Oprah Winfrey have also extolled the scans, which were given to more than 150,000 people in this country last year at a cost exceeding $100 million. Their use is expected to soar through the next decade. But there is scant evidence that the scans benefit most patients.
Increasing use of the scans, formally known as CT angiograms, is part of a much larger trend in American medicine. A..
(Excerpt) Read more at nytimes.com ...
Then what is he in a cardio's office for? He's using a cardio as an internist? This is anecdotal at best.
I would argue if you are in a cardio's office, you are there because you were referred. And if you were referred, odds are you are going to get a stress test first, and a CT later. Off to the hospital with you. The hospital with the enormous overhead and waiting list.
Yes, doctors will try to enhance their profits to pay those enormous malpractice premiums. Why not invest in your own practice instead of sending patients to a CT clinic or hospital? If you misuse the devices, the community will know pretty quickly.
I chose to have a CT scan to get a baseline data point. I paid for it totally at my own expense. The test was done at 2:00AM when the machine was otherwise not busy. I weighed the risk of radiation exposure and decided it was minimal. Tell me how this is bad?
because the benefit of the study has never been proven
Considering the fact that for most heart attacks, the first symptons are the last symptoms. - Consider Tim Russert.
If Every person was CT scanned when they turn, say 50, for clogged arteries, many lives would be saved.
As for the concern about x-rays, If you drop dead of a Heart attack, the exposure to x-rays will not matter.
This is just common Sense.
Bill from Nutley
Did you read all of my post #6? I can’t have an MRI. CT scans are the only way to get a good look inside of me without cutting me open. I think that’s a pretty good benefit.
If administrators are pressuring doctors to perform unnecessary tests they should be punished as well as the doctors that order them.
I’m not surprised that the NY Times is critical of a private enterprise while lamenting the impact to a government program. The problem with Medicare rests squarely on the government’s shoulders.
Things change! Remember that relatively speaking, the technology is still in its infancy.
And one of the biggest priorities in innovation is to reduce the radiation level. While the current background risk to a child of getting lethal cancer in their life is about 23%, one or more CT scans may raise this by as much as 1%. However, that is strongly balanced by the downward trend of cancer lethality across the board.
In another area, the number of “slices” a CT scanner could do in the early 1990s was 2. Now it is 320. This radically speeds up the time involved and increases resolution, though it increases radiation dose as well. But it shows the innovation involved in improving the technology.
On top of that, recent innovations in nanotechnology are now making it possible to take a prophylaxis prior to radiation exposure that limits the damage of ionizing radiation.
Finally, alternative systems to CT scanning are also making advances. For example, the South African diamond mines have innovated a low power whole body X-Ray machine to look for diamonds. This could soon become standard equipment in emergency rooms.
Polybius, this isn’t solely at you it’s just convenient to reply to your post.
There seems to be a general bias against the private sector on this thread. If the private business is proven unethical then it should suffer consequences. But this business is only contemplating buying the tool it may use in the future. Some here seem to be saying that it’s inevitable that it will be misused. That’s like saying that guns kill people.
Well, actually I AM the CT private sector.
The problem is not the private sector or privately owned scanners but the conflict of interest in ordering high-priced procedures if the referring doctor himself gets a financial bonus every time he orders such a high-priced procedure.
It's like the radiologist getting a financial kickback every time he mentions that something on CT or MRI or X-ray should be followed by a surgical consult for physical exam or biopsy or colonoscopy by the surgeon. In such a case, some radiologists would have a shuttle service between their Imaging Center and the surgeon's office.
Likewise for referring doctors who are not radiologists that get a financial kickback for ordering expensive imaging studies.
In the early 1990's, our radiology group was in competition with another radiology group in town that had invited the neurologist and the orthopeadic surgeon in town to be "investors" in their CT and MRI business. The more CT's and MRI's the neurologist and the orthopeadic surgeon ordered, the more money they would have at the end of the year.
For an initial $10,000 "investment", these guys were getting almost $100,000 per year in "investment returns" (read "kickbacks") just for ordering MRI's and CT's like they were ordering beer at Oktoberfest.
Our group never did that. Out referrals came only from physicians that had no financial stake in our MRI or CT and would not profit from ordering unnecessary CT's and MRI's.
In the end, the Feds ordered the other radiology group to divest itself of their equipment due to the abuse. They ended up having to sell the equipment to a private HMO and working only for professional fees without technical component profits.
The newspaper article in the nearest major metropolitan area that described the case started like this, as I recall:
"Mrs. Jane Wilson called her orthopedic surgeon's office on the phone to make an appointment about some low lumbar pain she was having. Without examining Mrs. Wilson, seeing her or even talking to her on the phone, her orthopedic surgeon, Dr. John Doe, ordered a C-Spine MRI, a Thoracic-Spine MRI and a Lumbar-Spine MRI at Acme Imaging, Inc. The bill from Acme Imaging for the combined MRI's totaled a staggering $(X amount). Mrs. Wilson, who had no pain at all in the Thoracic-Spine or Cervical-Spine regions was later shocked to find that Dr. Doe had a financial interest in Acme Imaging and that the C-Spine and Thoracic-Spine MRI's contributed to his own income if not to adding any useful information about her lower lumbar pain."
It sounds like your competitor got what was deserved. It also sounds like your practice is one I would like and trust.
What I don’t like is the stereotype of business being inherently greedy and evil. I’m not saying you are doing that. With your anectode above that would be quite a stretch.
I own and operate a business and have seen some unethical operators get their just desserts. Businesses that don’t operate ethically don’t deserve to continue. But give them the benefit of the doubt until they demonstrate bad behaviour.
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