Too Many Unnecessary MRIs and CT Scans?

Dr. Jon LaPook Looks Takes a Closer Look at Health Care Costs in the Users Guide to Health Care Reform

(CBS)  In our healt hcare system, scanning has become a prime example of technology's unintended consequences.

Molly Birnbaum was in a car accident that left her with multiple injuries. She fractured her pelvis, and hurt her knee.

"I broke the windshield with the back of my skull," she said.

She was given a total of nine CT scans during her week-long hospital stay. Doctors wanted even more, but her father, resisted. And he's a radiologist.

"At that point, I drew a line in the sand and said, absolutely not. There is no reason to do this anymore," said Dr. Steve Birnbaum.

CT scans use radiation similar to x-rays. MRI's use magnetic fields. Doctors order one or the other depending on what they're looking for. Both have revolutionized medical diagnosis.

Health Care Special Report
American College of Radiology
More about CT Scans
More about MRIs

The problem is a growing number of critics say tests like these are overused.

"We're definitely doing too many procedures," said Dr. Howard Forman, Professor of Radiology at Yale School of Medicine. "Every time we work in the ER or in the in-patient setting, after the fact, it becomes very obvious that certain studies either could've been avoided, delayed or not done at all."

Now there's also widespread concern over skyrocketing costs.

CT scans are big money makers, costing anywhere from $300 to $1,000. MRIs run as high as $1300.

The annual price tag for imaging? $100 billon. And experts estimate 35 percent of these tests aren't even necessary. That's potentially $35 billion wasted every year.

Forman says faster machines are helping to drive demand. "Fifteen years ago, the CT scanner would scan at a rate that could maybe get 3 or 4 patients through in a given hour. Now if you have able-bodied people moving the patient on and off the table, you could probably do a dozen or more patients in an hour."

In fact, from 2000 to 2007 the annual number of CT scans almost doubled to 69 million.

"It's too easy, too fast, too good. So it's much easier to order the test than it is to observe the patient, to monitor the patient," said Dr. Steve Birnbaum, "and avoid doing the CT scan."

Then there is the potential harm to patient safety. Experts are concerned that tests like CT scans - which use radiation - might increase the risk of cancer.

So how do you fix the overuse of CT scans and other high tech procedures?

The bills before Congress aim to reduce Medicare payment rates for scanning, increase funding for studies comparing different treatments to see what works best, and encourage conversion to electronic medical records. So tests aren't mistakenly duplicated and doctors have a database of results to learn from.

But some people aren't waiting for Washington's version of reform. Motivated by his daughter's experience, Dr. Birnbaum started a program flagging doctors if a patient seems to be receiving too many tests.

I'm very pleased with the results. I feel like I've done something in the fall of my career to really help patients," Dr. Birnbaum said.

Patients have to take responsibility, too. So often they demand instant answers and high tech tests.

But giving patients what they want is not necessarily what's best for them. Doctors need to spend time doing a careful history and physical before you can reassure somebody that their pain could be from something innocent. It's a lot quicker and easier to order a scan.

[atlantasummer]

Aren't you forgetting the single most important cause of overuse of imaging tests????

Have you ever heard of defensive medicine because of fear of MEDICAL MALPRACTICE LAWSUITS???

The report said that 35% of imaging tests are medically unnecessary. I believe that figure and would say the actual percentage may be even higher. However, the reason is fear of MEDICAL MALPRACTICE. Every physician I know orders tests that they know the patient doesn't need, but they feel they have to order that test to protect against a lawsuit.

Medical malpractice was not even mentioned in this CBS report.

If you really want to cut medical costs then do some studies that look at the following:

1. Waste from defensive medicine.
2. Waste from the bureaucratic nightmares that insurance companies, HMO's and medicare place on physicians and patients alike.

Instead of blaming doctors for everything, why don't you look at the players that are making obscene profits from the healthcare industry without providing any care at all - ie malpractice lawyers, insurance CEO's. How much money did the CEO's of Aetna and United Healthcare make last year?? Compare that figure with physician salaries.

[navwig]

I recently had what could have been considered an Unnecessary ct scan and it may have saved my life. I went in with a hernia and come to find out I have a growth on my right kidney. I had been having no symptoms that would have led me to believe a kidney problem existed. As it now stands they may be able to save the kidney any later and maybe not. Now if they would have done a ct scan earlier instead of shoving a finger up my butt for a prostrate exam they might have caught it sooner. Maybe a full body ct scan should be done at certain time intervals for at risk people. say starting at 40 for everyone and 5 year intervals from there but if something found you can shorten intervals. This could save many lives. CBS YOUR WRONG REPORTING IT LIKE THIS CT SCANS SAVE LIVES. I was told my pains are just a part of getting older.

[KickThemAllOutOfOffice]

Apparently liars are as scarce on Capitol Hill as sand is scarce at
the beach. The Senate recently approved a 2% salary increase for all
federal employees effective January 1, 2010.

Members of the executive, legislative and judicial branch are due for
an automatic pay increase in January as well. All this on the backs of
seniors who will not incur any COLA increases for several years. For
the first time in history, the Congress will not allow an increase in
the social security COLA (cost of living adjustment). In fact, The
Henry J Kaiser Family Foundation predicts there may not be any COLA
for the next three years.

However, the per person monthly Medicare insurance premium will be
increased from the 2009 premium of $96.40 to $104.20 in 2010 and to

$120.20 for the year 2011.

Send this to all seniors that you know. Remind them to not vote for
the incumbent senators or congressmen.

[JENNX1HX1]

I WORK IN THE HEALTHCARE INDUSTRY DOING AUTHORIZATIONS FOR CERTAIN DIAGNOSTIC PROCEDURES SUCH AS MRI'S CT'S AND SURGERIES....I WOULD LIKE TO KNOW SOMETHING....THE STUDY CONCLUDES THAT 35% OF TESTING IS NOT NECESSARY, IS THAT BEFORE OR AFTER THE TEST WAS PERFORMED? WHEN YOU ARE SICK AND NOT FEELING WELL AND THE DOCTOR WANTS TO RULE OUT AN ANEURYSM OR TUMOR OR FRACTURE,WOULD'NT IT BE EASIER TO HAVE AN IMAGING TEST RATHER THEN GO THROUGH OTHER VARIOUS TESTING FIRST? SOMETIMES AN MRI OR CT CAN FIND THINGS LIKE CANCER EARLY ENOUGH TO BE TREATED....THE PEOPLE DOING THESE CLINICAL STUDIES (LIKE NIA, CARE CORE AND MED SOLUTIONS) ARE NOT DOCTORS OR NURSES. THEY MAKE LIFE CHANGING DECISIONS...I THINK IF A DIAGNOSIS CAN BE MADE AS SOON AS POSSIBLE, IT WOULD BE IN THE PATIENTS BEST INTEREST, SO WHY NOT UTILIZE THESE TESTS, NOT ABUSE THEM.

[gramto8]

My late husband was the CT tech on duty one night while I was the unit secretary in the ER. One of our ER patients came in with a laceration to the front of his head, just inside the hairline. Our doc cleaned and sutured and was ready to discharge this patient, but decided to do a CT 'just in case.' My husband was totally pi...ed off. He always raised Cain (at me) when the ER did this. I got to see him come back to the ER with his tail between his legs when he asked our doc to come look at the pictures on the scope, even before he printed the films. This 'just in case' CT found that the board that had split the skin on this man's head had a nail in it. The nail had penetrated the skull and entered between the halves of the brain. Dirt and air were inside the skull. Hubby never again said anything about the 'just in case' studies.

The patient was shipped to a larger facility that had neurosurgery and was ok.

[smoknmirrors]

"...after the fact, it becomes very obvious" should be engraved on every tombstone. After nine CTs, he "drew a line in the sand;" why not after two or four or six? If a professional radiologist cannot call the precise number needed, what chance does a layman have? If doctors don't want lawyers interfering in the quality of care given their patients, stop your negligence, carelessness and reckless behaviors. The lawyers don't get involved until after the fact, and by then, it has become very obvious.

[sammy111537]

Katie..I'd like to see you do a follow up story on this and focus on the Federal Stark Regulations that allows doctors to have diagnostic imaging equipment within their office...and they get a cut off every one they do..yes, they make money off of the amount of tests they order...so why wouldn't they order as many tests as they'd get paid for.
Hospitals can't do this..no one gets a cut when you have an imaging test done at a hospital....hospitals don't abuse this..but independent physician clinics do.
When you come into the ER..many times the docs don't have time to wait to see how you do...they need to look inside quickly to save your life.
In many cases diagnostic imaging is much much better..and less costly than going into an OR to look inside.
It is fantastic technology...that we should be grateful for..but docs should not make money off the pain and suffering of others.
Physician self referral to service or places they have a financial interest in is wrong. When this is allowed to happen it is not always what's best for the patient but what puts money in the doctors pocket.

[govmess]

Obama recently approved a 2% salary increase for all federal employees effective January 1, 2010. Members of the executive, legislative and judicial branch are due for an automatic pay increase in January as well. All this on the backs of seniors who will not incur any COLA increases for several years.


For the first time in history, the Congress will not allow an increase in the social security COLA (cost of living adjustment).

In fact, The Henry J.. Kaiser Family Foundation predicts there may
not be any COLA for the next three years.

However, the per person monthly Medicare insurance premium will be increased from the 2009 premium of $96.40 to $104.20 in 2010 and to $120.20 for the year 2011.

I encourage all seniors not to vote for the incumbent senators/representatives in your state in upcoming elections. It is time WE changed Washington since Obama promised change but has not delivered on his promise!!

[maybury1851]

I happen to have to pleasure of working with Dr. Birnbaum as one of his team members who has developed the tracking database he speaks about. This is just a small amount of patient's, about 200, that we have so far....BUT for those 200 patient's it means everytime they come to the EW or the hospital for a CT scan, a red flag goes up. It gives the opportunity to have a dialogue with the patient's attending MD or the EW MD and possibly look at another test that doesn't use ionizing radiation to get the same answer. Maybe in some cases that is not possible and the patient needs that scan of the abdomen again to rule out a severe diverticulitis or abcess. This is saying that we should completely shutoff performing imaging tests on patients, our program gives us the opportunity to look at those we tracking and possibly offer them some other exam without the ionizing radiation. Take a look at the statistics on the web about how much radiation 1 CT scan of the abdomen is equal to. It is a considerable amount which is why especially for chronically ill patients that come into your EW all the time keep getting scanned over and over again. This is madness ! We just need to take a step back and look at all the wonderful imaging procedures we have before we just order the one that is the easiest and the fastest, CT Scans ! We are talking about Hiroshima levels of radiation in some cases for patients who are chronically ill. The problem is how can we get every hospital to participate in some sort of tracking mechanism for these patient's. Not an easy task !

Sincerely,

maybury1851...

[vonBismarc]

sorry for the duplication, i thought i only hit submit once.