Hospitals Performed Needless Double CT Scans, Records Show

[Guest guest]

BlankJune 17, 2011

Hospitals Performed Needless Double CT Scans, Records Show

By WALT BOGDANICH and JO CRAVEN McGINTY

Long after questions were first raised about the overuse of powerful CT scans,

hundreds of hospitals across the country needlessly exposed patients to

radiation by scanning their chests twice on the same day, according to federal

records and interviews with researchers.

Performing two scans in succession is rarely necessary, radiologists say, yet

some hospitals were doing that more than 80 percent of the time for their

Medicare chest patients, according to Medicare outpatient claims from 2008, the

most recent year available. The rate is typically less than 1 percent, or in

some cases zero, at major university teaching hospitals.

Next month, the Center for Medicare and Medicaid Services is expected to release

figures for 2009, but according to people who have seen the numbers, the

practice of double scanning chest patients has continued.

“When I saw the 2009 numbers, they were the same essentially, and I was

disquieted by that,” said Dr. J. Pentecost, a radiologist and Medicare

consultant who also reviews claims for commercial clients.

The overuse of scans has been the subject of growing concern in recent years,

but a review of the federal data, focusing on a common procedure performed

millions of times a year, offers a rare and detailed snapshot of the problem

state by state, hospital by hospital.

In 2008, about 75,000 patients received double scans, one using iodine contrast

to check blood flow, and one that did not. “If you do both, you bill for both,”

Dr. Pentecost said.

Radiologists say one scan or the other is needed depending on the patient’s

condition, but rarely both. Double scanning is also common among privately

insured patients who tend to be younger.

Double scans expose patients to extra radiation while heaping millions of

dollars in extra costs on an already overburdened Medicare program. A single CT

scan of the chest is equal to about 350 standard chest X-rays, so two scans are

twice that amount.

“The primary concern relates to radiation exposure,” said Dr. A. Brink,

chief of diagnostic radiology at Yale-New Haven Hospital, where double scans

accounted for only a fraction of 1 percent of cases. He added: “It is incumbent

upon all of us to limit it to the amount needed to make a diagnosis.”

Officials at hospitals with high scan rates said radiologists ordered the extra

chest scan figuring that more information is better. In rare instances, the two

scans might help a doctor distinguish between tangled blood vessels and a tumor,

Dr. Pentecost said.

The Medicare agency distributed the data to hospitals last year to show how they

performed relative to each other and to encourage more efficient, safer

practices. The review of that data found more than 200 hospitals that

administered double scans on more than 30 percent of their Medicare outpatients

— a percentage that the federal agency and radiology experts considers far too

high. The national average is 5.4 percent.

Full story

http://www.nytimes.com/2011/06/18/health/18radiation.html?_r=1 & nl=todaysheadline\

s & emc=tha2 & pagewanted=print

or http://tiny.cc/zi6pb

[Guest guest]

One physician I spoke to said imaging is a major source of revenue for

hospitals. So there's an incentive to over image patients who are insured in

order to pay for services provided to the uninsured. .... It's a cost shifting

measure that's needed to keep the hospitals open.

If true, this contributes to the ever-rising cost of insurance premiums.

Karl