On whole body CT scans

As a radiologist I would like to comment. The mainstream radiologic community is in agreement with you on this one and the ACR has issued a formal statement not recommending these scans. That said, let’s look at the reality of why many groups, including my own are offering these.

In many large cities, the competition for imaging services is intense. In some places, the prices are being driven so low, that the reimbursed costs don’t cover the costs of the procedures.

Mainstream radiology groups are generally those groups with one or more major hospital contracts, who may also have outpatient imaging centers as well, sometimes alone and sometimes in conjunction with the hospitals that they contract with. We are under seige by individual imaging companies who may have no ties to a region and come in to a specific market and open up just to steal away outpatient business. They are only open during regular hours, never at night or on weekends and generally provide no consultative services to the local clinicians. The radiologists reading their studies may be on site but are often hundreds if not thousands of miles away, reading the studies by teleradiology.
When these outfits enter a market, they offer only those studies with decent reimbursements. You’ll never see an outside company come in and offer mammography services, let’s say. Just doesn’t pay and not worth the risk.
They offer these total body scans. If an irregularity is seen generally they do the followup diagnostic studies. Once a patient has utilized their services they are more than likely to go back if they need additional imaging. This results in the mainstream groups losing their better reimbursed studies and patients.

The result is these groups are providing 24 hour coverage and watch their patient profiles suddently shift to higher percentage of medicare, medicaid, and no pays, typically through the emergency room.Trust me, this has happened to my former group. Before you know it, you’re working like a dog, with very complicated and time intensive work, with little or no revenue and high litigation risk, while your better paying patients are being seen elsewhere. As all physicians know, in order for a practice to function well, you need a share of all kinds of patients. Better reimbursed patients allow you to provide care to those who can’t or dont’t.

So the bottom line, is to stay in business, you have to compete. And as these outside outfits offer these scans mainly to attract patients, we are forced to do the same to try and maintain our already existing patients as well as our patient mix.

And if you think, that these forces are not for real, let me state that my last group was forced to call it quits after providing continuous service to our hospital for over 75 years, because such intense competition coupled with rising expenses, particularly billing and rising malpractice premiums reduced our compensation to virtually nothing. Now, I’m all for not getting paid too much for not doing too much work. But we were working an average workload about 35-60% above the annual recommended radiologist case load, with frequent and horrible call nights and weekends, and tremendous “no pay” hospital responsibilities, for example, departmental management and tremendous hospital committee responsibilities. Desperate times call for desperate measures. I’m not proud to say it, but you either sink or swim.

I have been a healthcare marketer for over 17 years and there is a simple reason for the marketing of these tests: MONEY! The current model in healthcare is such that few rarely care about the efficacy or morality of what we are doing anymore, it’s the reimbursement game, baby, it’s working the system…it’s the bucks that matter, not patient care. To paraphrase Janis Joplin, “Healthcare’s just another word for nothing left to lose.” The more the medical establishment doesn’t police itself, the more such issues will continue to face us and the more we will prey upon the public’s unfounded fears and unrealistic hopes that we can fix every damn thing that goes naturally wrong.

Great comments. The author wrote a great article. I hope the situation bothers the readers. I appreciate the comments and agree entirely. This is an undesirable trend.