The Medical Mutual Liability Insurance Society of Maryland has proposed a 2% cut in its premiums, adding to an 8% cut made late last year. The gradual rate decrease by the state's biggest medical malpractice insurer is said to help doctors avoid financial disasters.
You wait in potential terror for the results. Either you or your child goes through a CT or an MRI, and wait to know whether or not the physician will see something that should not be there.
Luckily in my case, the news has always been good. "Everything looks normal," the doctor says, and the diagnosis is altered to reflect what is actually seen versus what is suspected.
To physician and patient, this scan served a purpose: elimination and peace of mind, respectively. To payers, that scan may have been an unnecessary expense, a "cover-your-behind" test by the doctor and an uneducated and expensive reassurance for the patient. Right now, the proliferation of advanced diagnostic imaging is in the cross-hairs of state and federal politicians, as well as health plans, as the dollars become tight in healthcare and fat becomes vulnerable.
Recent weeks have seen renewed chatter in the imaging debate, starting with a GAO report that tracked an increase in Medicare Part B imaging expenditures that rose from $6.89 billion in 2000 to $14.11 billion in 2006. While rising expenditures may be the symptom, Sen. Chuck Grassley sees the relative ease of physician self-referral as the illness, so he has introduced a bill that would amend the in-office ancillary services exception to the Stark self-referral rule by, among other things, requiring physicians to disclose any financial ties in imaging centers to patients, and to even provide a list of conveniently located alternative locations.
While the government wants to provide information in the imaging decision process, the health plan industry wants to be more directly imbedded. WellPoint, Anthem and other commercial insurers are turning to pre-screening, and reporting significant drops in radiology growth trends. AHIP has upped the rhetoric coming from the health plan side, with a report—none-too-subtly titled "Ensuring Quality Through Appropriate Use of Diagnostic Imaging"—quoted studies that found 20% to 50% of advanced diagnostic imaging procedures failed to provide information that was helpful to the diagnosis, and that unnecessary tests add $26.5 billion to healthcare costs. The American College of Radiology agrees with the conclusion that financial incentives for in-office referral are a driver of imaging costs, but they oppose the use of pre-authorization intermediaries because they "would take medical decisions out of the hands of doctors."
The ACR instead recommends mandatory accreditation of all advanced imaging services providers who would follow guidelines for the appropriate use of scans.
While the national players compete for the policy and funding pie, the issues of growth and duplication of services pop up in markets like St. Louis and Minneapolis/St. Paul.
Behind all the rhetoric, studies, numbers, and dire threats being pushed around is the central question: When should the healthcare industry tell a patient "no"? It's hidden in a layer of clutter, but it is the very type of cost-versus-benefit question that the industry and country will have to face in the coming years. This is where high-technology, high-cost, and high-diagnostic value intersect. Can you tell me what tests I can't have? Will I pay for it anyway?
As one leading radiologist told me this week, "advanced imaging enables the modern practice of medicine." The potential for these modalities to see disease at its earliest stages has enormous potential for saving lives. So while no patient ever looks forward to a CT or an MRI, telling me that I can't have one is a different line to cross.
Jim Molpus is Editor-in-Chief of HealthLeaders Media. He can be reached at jmolpus@healthleadersmedia.com.
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San Pablo, CA-based Doctors Medical Center has made its interim chief executive officer, Joseph Stewart, a permanent one. The West Contra Costa Healthcare District board, one of two panels that run the hospital, approved the appointment 4-1 at a meeting. The board also interviewed a second candidate, whose name is not being disclosed.
The Snohomish, WA, Health District is facing a $4.4 million budget shortfall that could jeopardize programs to fight communicable diseases and promote maternal and child health. Administrators say 35 employees will likely be laid off as part of the first round of cuts. The reductions come as health departments around the state face similar funding crises. The economic slowdown has meant plummeting tax revenues for the state and local governments that fund public health at the same time rising medical costs make it harder for families to afford private care.
Rodney E. Miller, administrator and chief operating officer of Memorial Regional Hospital in Miami, has resigned from his $370,000 job after being the subject of a government investigation that found "fraud and mismanagement" at a Virgin Islands medical center he ran until last year. A report by the islands' inspector general said Miller had pocketed $1.3 million over five years "in excess of the amounts specified in the employment contracts." Frank Sacco, chief executive of the Memorial Healthcare System, said the system did all it could to check into Miller’s past, but Miller misled them in his application.
The number of people admitted to the hospital for heart attacks fell by 17% in the year after Scotland’s smoking ban took effect in March 2006, according to a study. The study’s author says the size of the decline strongly suggests it was the smoke-free law and not some other trend or lifestyle change that prevented the heart attacks. In the decade before the law was in place, heart attack admissions fell by an average of about 3% a year. And heart attacks fell by 4% in the same period in neighboring England, where a smoking ban took effect beginning in July 2007.