Overtreated with unnecessary CT scans

June 30th, 2008 | by Brian Schwartz |

The New York Times reports on how expensive CT scans for heart disease are often unneccessary, and relates one case where the patient probably did not need the scan:  The doctor “said the scan would be valuable anyway because it might reassure him. And his insurance would cover the cost.”  

I understand the motivation to want reassurance.  But that’s a lot easier to ask for when insurance covers it, so it appears free to the patient, or prepaid through his insurance premiums.   Yet, our tax system subsidizes insurance, so we are more likely to buy policies that resemble prepaid medical care that insulates us from the true costs of wanting reassurance.

Writes the Times:

One reason for high health care costs is that some expensive tests are frequentyly used even when they have not been proven to provide more useful information that older and cheaper tests.

More from the article:

CT scans, which are typically billed at $500 to $1,500, have never been proved in large medical studies to be better than older or cheaper tests. And they expose patients to large doses of radiation, equivalent to at least several hundred X-rays, creating a small but real cancer risk. …

And yet, more than 1,000 other cardiologists and hospitals have installed CT scanners like the one Dr. Rosenblatt turned down. Many are promoting heart scans to patients with radio, Internet and newspaper ads. Time magazine and Oprah Winfrey have also extolled the scans, which were given to more than 150,000 people in this country last year at a cost exceeding $100 million. Their use is expected to soar through the next decade. But there is scant evidence that the scans benefit most patients. …

Sometimes, it is not the doctor but the patient who is eager for the scan. …

Dr. Hecht acknowledged that Mr. Franks probably did not have severe heart disease. But he said the scan would be valuable anyway because it might reassure him. And his insurance would cover the cost.

Arnold Kling comments:

The Times falsely says that “At a time when Americans are being forced to pay a growing share of their medical bills…”

If only. What the story misses, and what my book emphasizes, is that these expensive, discretionary medical procedures are spurred by insulating the consumer from the cost, thanks to what we call “insurance.”

In an earlier post, Kling describes this problem in depth:

For health care providers, insulation is a bonanza. Because consumers are not spending their own money, they accept doctors’ recommendations for services without questioning them and without concern for cost. Faced with an insured patient, a health care provider is like a restaurant catering to convention-goers with unlimited expense accounts. The customer will gladly take the most high-end recommendation and not worry about the price.

Consumers are happy as well. Insulation relieves the patient of the stress of making decisions about treatment. The patient also does not have to worry about shopping around for the best price.

The problem with insulation is that it is not a sustainable form of health care finance. Individuals, employers, and government are all under stress. …

Insulation leads people to over-consume health care services. Americans make extravagant use of services that have high costs and low benefits. Many studies that compare groups with similar conditions show that those with the largest levels of health care spending fare no better in terms of outcomes than those that spend less.

(HT, Arnold Kling, of course)

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  • What struck me in The New York Times article “Weighing the Costs of a CT Scan Inside the Heart” was what the story omitted: peer-reviewed and emerging clinical trial data showing that CTA scans produce cost savings and improve patient outcomes. Also, for a story of this length to leave out any discussion of appropriateness criteria – even though cardiology and radiology medical societies already have programs in place, and both criteria are part of the current policy discussion – is curious. In my estimation, it fails to offer readers balanced information to help inform their decisions.

    There are numerous peer-reviewed studies demonstrating that CT scans detect heart disease and help patients avoid cardiac catheterization. For example, the article could have cited a 2007 study in the Journal of the American College of Cardiology, which found that multi-slice heart scans significantly reduced diagnostic time and produced cost savings. It could have also cited a recent study demonstrating how CT heart scans are an effective and cost-saving tool in selecting patients for cardiac catheterization. The selective catheterization resulted in average cost savings of $1,454 per patient.

    Proper utilization of any medical technology is important, and the majority of doctors do use medical imaging appropriately, without standing to realize any financial gain from doing so. In fact, according to 2005 Medicare claims data, an average of 94% of CT, MRI, PET and SPECT referrals are made to physicians who do not order the tests, and that percentage is even higher for cardiac imaging. To address the small minority of instances when imaging is improperly used, policymakers and medical societies are embracing appropriateness criteria and accreditation requirements as effective solutions that allow health decisions to remain in the domain of physicians and patients rather than insurance companies. Unfortunately, The Times story made no mention of this either.

    CT heart scans eliminate the need for an invasive and expensive procedure to diagnose coronary artery disease by providing precise and comprehensive information on heart ailments without surgery and within seconds. Yes, a CT heart scan may seem expensive when viewed in isolation, but compare the price tag of a one time scan to the cumulative, long-term costs that will come with its regrettable alternatives: repetitive consultation and progression of disease and inappropriate treatment. Talk about penny wise and pound foolish—especially considering that coronary artery disease is the most common type of heart disease, and the number one killer for both men and women.

    Thankfully, Medicare’s recent heart CT scan coverage decision allowed continued patient access to these tremendously valuable scans, which have revolutionized the way doctors diagnose heart disease, and become the standard of care for cardiac disease throughout the country and the world. I am certain that patients across America are benefiting as a result, and in this vein, it is incumbent upon us and our healthcare system to ensure that physicians are continually armed with improved resources for diagnosing and treating disease more precisely, effectively and efficiently – not restricted in their ability to save lives.

    Andrew Whitman
    Vice President, Medical Imaging & Technology Alliance
    http://www.medicalimaging.org/
  • With respect to some of the factual medical claims made by the NYT, here is an excerpt from a rebuttal one of my partners wrote about the article:

    1) Our radiation dose in over 1200 scans is 12mSv, much less than the 21 mSv described in the article. This is about 2 years of background radiation in Denver.

    2) A majority of the scans we do change patient management. People without disease don’t need to be on a multi-drug (statin, niacin, anti-hypertensive, fibrate, omega 3 fatty acids, cholesterol absorption blockers) treatement regimen. Since the cost of statin (Lipitor for example) is $1000/yr, the cost of the exam for these patients is recouped in less than a year. People with disease often end up with more aggressive management or even invasive angiography that they would not have otherwise had. These people's lives may be saved. The recent example of Tim Russert points out the utility of CTA. His doctors were quoted as being "surprised" about the amount of plaque in his coronaries because he had had a normal stress test and a benign clinical picture. Better to get the CTA and be surprised while you're still alive rather than at autopsy.

    3.) CTA allows us to stop guessing if disease is present. Every other non-invasive test looks for secondary signs of disease; CTA actually looks at the plaque. A simple analogy is crossing the street: you could gather statistics about the probability of getting run over crossing this street (i.e., risk factors), or you could just look to see if there's a car coming (i.e., CTA).
  • Just as a FYI, our radiology group offers this particular type of cardiac CT test at multiple locations in the south Denver metro area, and they cost about $1200 or so:

    http://www.riainvision.com/invision/patientinfo/screening/patinfo_scrn_coronarycta.asp

    It is definitely the case that these are sometimes "overused" in the sense that they probably aren't medically necessary for some patients, whereas they are medically appropriate for other patients. But this is no different from any other test.

    For instance, a 25-year old woman with no special risks for breast cancer does not need a yearly breast MRI scan to check for possible cancer. On the other hand, we do know that it is a very reasonable test for certain young women who have one of the "breast cancer genes".

    We do offer these cardiac CT tests to many people who pay out of pocket (i.e,. their insurance doesn't cover the costs). In those cases, we are happy to explain the risks and benefits, and let them decide if the benefits are worth the financial costs and (small but real) radiation risks for their particular circumstances. Nearly every patient who has had to pay with his or her own hard-earned cash has generally asked good questions about the test and has been interested in making an informed choice about the procedure, as they would with any other form of consumer spending.

    I firmly believe that having to pony up their own money makes a big difference, and for the better.

    Paul Hsieh, MD
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