Doctor Self-Referrals – Physician Owned CT Scanners Questioned Again
Posted Jul 31 2009 6:48pm
Here goes the same question again, are they being over used. Well this time I’m going to speak out a bit from some personal experience where I worked with a physician’s practice, writing software that connected to the information from the CT scanner, which involved a bit of my time on premise so I was also an observer of what occurred in this office, they had a CT scanner on premise and it was a practice of 3 family/internists.
Did I see abuse here, not in my opinion, but did I see convenience for the patient, yes. The number of patients that came through the office that had scans were actually small. The practice was also intelligent enough to offer “retail scans” too, so in other words if a patient, on their own with no insurance coverage here, wanted to have a full body scan, heart scan, virtual colonoscopy, etc. they could. Now as far as I know there’s no law against wanting to have one and paying for it on your own account. If a practice is smart, they make the availability known to the patient, and if a scan is required, it can be done immediately. I saw many patients that appreciated that fact and they were happy with the quick diagnosis.
One other item too, the scans for diagnosis are specified they are for that purpose, and thus there is a separation between a retail patient and one for diagnosis. What I did while I was there was to create some additional business intelligence so the physicians could stay on top of those patients who had a high calcium score, in other words those at risk for heart disease and made it easy for automated letters to go out and remind those patients to come back for a check up, and we are not talking marginal here, we are talking over 300 or more on the score. One more thought to keep in mind, does one know the expense of keeping one of these units up? Well think about that side of the coin if you will as it is not cheap and actually when the repair and maintenance bills came in I occasionally used to hear some mutterings to the effect of “why did I get this machine”, so again, this is looking a the other side of the coin.
Again there’s always someone along the line that will abuse this, but from what I saw as an example I don’t think abuse is the case with most, it’s convenience and not having to wait until a hospital facility can do it a couple weeks or days down the road, and all the controversy over this notion is ludicrous. Now should there be occasional audits, sure, to make sure everyone is on track and if all is going the way it should, there’s nothing to worry about. Remember even when the CT scanner is on premise, insurance coverage still have to be verified. BD
In August 2005, doctors at Urological Associates, a medical practice on the Iowa-Illinois border, ordered nine CT scans for patients covered by Wellmark Blue Cross and Blue Shield insurance. In September that year, they ordered eight. But then the numbers rose steeply. The urologists ordered 35 scans in October, 41 in November and 55 in December. Within seven months, they were ordering scans at a rate that had climbed more than 700 percent.
A lawyer for the Iowa urology practice defended its medical decisions. "The standard of care for a certain category of patients may require a CT scan and the practice may have decided to purchase a CT scan as a result," Victor Moldovan said in an e-mail. "Any assertion that there is some wrongdoing simply because of an increase in scans is unfounded." The urology practice, he added, "understands its obligations very well and complies with all applicable standards."
Physicians, medical associations and imaging-device manufacturers argue that allowing doctors to own and operate scanners increases patient convenience and allows quicker diagnoses.
"It is important for legislators not to take tools out of the hands of doctors," said Jim York, an orthopedic surgeon and president of the Maryland Patient Care and Access Coalition, a group fighting to allow physicians to operate their own scanners.
"Just because doctors have CT scanners in their office does not mean they are abusing the system," Siegel said."Is everyone a Bernie Madoff or a crooked politician? Most doctors are dedicated to providing outstanding patient care. They don't think, 'A CT scan is coming and I am going to make money.' They think, 'A patient needs a blood test or a scan, and I am doing it for him.' "