BRINGING MEDICINE BACK TO BASICS: PHYSICIANS’
ORDERS SHOULD BE FINAL ORDERS
Dateline: March 28, 2008 ... Los Angeles, CA
Contact: T.L. Kittle
Phone: (323) 843-4200
Fax: (323) 375-0137
E-Mail: tlkittlemedicalindustry@yahoo.com
LOS ANGELES, CA - March 28, 2008 - An article published in Yahoo on
Sunday, March 24, 2008, “Health Insurers limit advanced scans” by
Linda A. Johnson, AP Business writer, failed to address the other side
of the medical debate: imaging tests that don’t pose health risks (ie,
MRIs and ultrasounds), the number of patients who have been hurt
because they were not able to access an imaging test when they needed
it, as well as the impact in general of the deterioration of the lack
of physician control over health care has had on patient care—do we
want our physicians to be physicians, or do we want our physicians to
go through medical school to spending an increasing part of their day
acting as secretaries?
Since there is endless value in the knowledge that comes from seeing
someone in person, evaluating and touching them physically, no person
or organization should ever have the authority to override or cancel
the course of medical action made by a physician in consultation with
his or her patient. Since physicians are often held up to medical
malpractice standards if they make medical decisions regarding a
patient without performing an examination, I’m not sure why a company
or an organization would be exempt from such laws. And then the
physician gets pulled into the courtroom for medical malpractice when
something goes wrong? How is that fair when they couldn’t even control
the timeliness of the medical care that was provided to their patient?
If we’re going to hold them accountable for errors, then we need to
give them control over the decisions.
I understand the potential risks of CT scans, but this article failed
to address the imaging tests that have been proven to save lives
without posing health risks, like MRIs and ultrasounds, as well as
failed to address the number of people who have been unnecessarily
hurt because they were not able to access the imaging tests that they
needed when they needed it, due to the burden such approval processes
place on the medical system. I find it difficult to feel sorry for the
insurance companies and their cries regarding costs when their profit
margins are in the millions of dollars. For the sake of giving
adequate medical care to the suffering, it’s long overdue to put
directing the course of medical care back into the hands of the people
who have been trained to do that job and who have given us a physical
examination: our physicians.
T. L. Kittle suffers with a chronic illness in the Los Angeles area,
gratefully under the care of a number of extraordinary physicians.
Kittle is currently in the process of establishing a non-profit
specifically designed to address concerns regarding lack of access to
care as well as lack of physician control over medical care.
Link to the article:
http://news.yahoo.com/s/ap/20080323/ap_on_bi_ge/limiting_medical_scans
;_ylt=AkXsufXeQuK7GDu9BhxjV_mKOrgF
Health insurers limit advanced scans By LINDA A. JOHNSON, AP Business
Writer Sun Mar 23, 1:46 PM ET
TRENTON, N.J. - Insurance companies are taking a harder look at
advanced medical scans like CT scans, citing spiraling costs and
safety concerns. And some doctors agree there's emerging evidence that
these scans are being over-prescribed.
"Costs are soaring in this area, quality concerns are mounting and
safety concerns are mounting," said Karen Ignagni, chief executive
officer of the trade group America's Health Insurance Plan. Health
insurers are requiring more pre-authorizations before patients can
receive these scans, and setting other restrictions including
mandating that the imaging equipment and medical staff operating it be
credentialed in advance.
Insurers fear some patients are being exposed to dangerous radiation
levels from having repeated CT and PET scans, which use many times the
radiation of a regular chest X-ray. Sometimes scans are repeated
because the first ones were not done properly, using outdated
equipment or by poorly trained technicians. Doctors, too, are
concerned about patients getting excessive radiation exposure when
they receive scans that aren't needed or are ordered as "defensive
medicine" to protect against possible lawsuits. There also is concern
that a small number of unscrupulous doctors without adequate expertise
are referring patients for tests in their own offices or imaging
facilities in which they have a financial interest. "There is a
definite concern that in-office imaging could lead to scanning for
dollars," said Dr. Robert Hendel, a heart specialist who sits on
American College of Cardiology panels focused on quality and
appropriateness of imaging. But doctor experts say the bigger problem
with medical imaging tests is the insurance red tape needed to get
them. "Is this a preauthorization process or are these (insurance)
companies practicing medicine?" asks Dr. Arl Van Moore, board chairman
at the American College of Radiology, the specialists in medical
imaging. Moore cited another reason for increasing costs: Doctors
sometimes order a diagnostic test that doesn't need preauthorization —
even if it provides less-helpful information than the one they prefer
— then seek approval for a more advanced test if the first one shows
it's needed.
Worse yet, sometimes patients end up getting a riskier, more invasive
test than what they really need, said Hendel. For example,
cardiologists wanting to assess blood flow and blockages inside a
patient's heart arteries would prefer a nuclear cardiology test. With
that, a small amount of a radioactive substance is injected in the
blood and tracked using a camera. Some doctors will instead order a
cardiac catheterization, which doesn't require advance authorization,
Hendel said. But that involves threading a catheter through a blood
vessel up into the patient's heart — and carries a 10- times higher
risk of complications such as a heart attack or stroke, he said.
The two doctor specialist groups are fighting improper use of scans by
supporting accreditation of the machines and doctors using them and by
publicizing criteria for quality and appropriateness of various
imaging tests. "There is substantial evidence that these types of
techniques, when used appropriately — and I want to emphasize the word
'appropriately' — can keep the lid on expenses and improve outcomes,"
such as by catching cardiac problems early enough to prevent a heart
attack, Hendel said. Patients who are inconvenienced tend to blame the
doctor and office staff, Hendel noted. "They (patients) show up
expecting a test to be performed. We've booked a slot," and then
discover the problem, Hendel said. "We have no choice but to
reschedule. Are they upset? Yes!" He said use of strategies to hold
down imaging costs was fairly limited until last year, when it really
ramped up, triggering the growth of a new industry of insurance
consultants called radiology benefit managers.
A recent study by the Center for Studying Health System Change, which
is funded by the Robert Wood Johnson Foundation of Plainsboro, N.J.,
the nation's biggest health care charity, also found that limitations
on use of MRIs, CT scans, PET scans and nuclear cardiology imaging
became widespread last year. The report was based on visits and
interviews in 2007 with officials of health plans, hospitals, doctors'
practices, major employers and others in 12 metropolitan areas. The
report noted use of CT scans in the U.S. nearly doubled between 2000
and 2005, from 12 scans per 100 people to 22 per 100. That's partly
because improved technology has made the imaging machines, which can
cost million to million each, useful for diagnosing more
problems. "The hospitals and physicians purchase it, and then there's
a strong incentive to use the equipment," said Ignani, the insurance
trade group CEO, adding that manufacturers aggressively market the
machines. Revenues from the tests, which can run 0 to ,000 or
more apiece, can be tempting to financially struggling hospitals and
doctors squeezed by shrinking reimbursements from government health
programs and commercial insurers.
At least one medical education firm is pitching a training conference
titled: "Practice Expansion for Primary Care Physicians: How to Grow
Your Income by Adding In-Office Imaging!" The insurer restrictions
seem to be working: After one health plan that was seeing 20 percent
annual jumps in advanced imaging use began requiring preauthorization,
its growth rate plunged. Yet the insurer said only 1.5 percent of
requests were being denied, indicating doctors were ordering fewer
tests, according to the report. "Most health plans believe it's been
successful," said Ann Tynan, the study's lead author. Insurers are
looking at ways to put similar restrictions on other high-cost areas,
and some already are doing so for stomach- reduction surgery and very
expensive medications, she said. Doctors see some hopeful signs,
though, after passionate arguments by physician groups reversed
changes they were fighting. The Medicare program is trying to find
ways to hold down its spending on imaging services after the annual
cost jumped from billion in 2000 to billion in 2005. It had
proposed no longer paying for cardiac CT scans unless patients were
enrolled in a study of their effectiveness. In mid-March, it said it
would continue to cover the scans. And Horizon Blue Cross Blue Shield
of New Jersey, the state's biggest insurer, recently halted a plan to
require preauthorization for relatively inexpensive EKGs, or
echocardiograms, even though it is starting to require advance
approval for expensive cardiac imaging. On the Net: Study by Center
for Studying Health System Change:
http://hschange.org/CONTENT/968/
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