Saturday, September 15, 2007

Self Referal from a different angle

Ok there has been a lot of talk and news lately about evils of self referral. While I am in agreement with all the arguments against self referral I think there is another issue that is being skipped over. If the government isn’t going to stop self referral, which quite honestly I don’t think they can, will, or have a real desire to, then they need to at least regulate the quality of the equipment used in these offices. Not only are the Doctors using this equipment ordering more tests than they ever did before they had their own machines, which some studies suggest is an increase of 2 to 6 times the number of studies ordered, but the patients are unaware that some of the scans that they are getting are inferior to a scan that may be obtained at a local hospital due to the age of the equipment being used. In addition to that with a lot of the old CT scanners the radiation doses that the patients are getting are a good deal higher when compared to the new technology employed by the current generation of CT scanners. Think about it, would you rather have a study done on a scanner that is from 1992 with technology from that time or a study done using technology from the last 5 or so years? I know which one I would send my family members to.

The other part of this issue which I have a SERIOUS problem is that the reimbursements are the same and sometimes higher for these scans performed on inferior equipment than the reimbursements given for scans done in hospitals on scanners using the newer and better technology. This is eventually going to make hospitals think twice before updating to newer and better technology for the scanners they use. It may even prevent some hospitals from being able to afford to upgrade to the latest technology. Now I am not a huge fan of upgrading for the sake of upgrading but if there is a new technology that is going to detect and therefore help prevent, by way of earlier detection, diseases or anomalies I would like to think that the hospital I go to has that technology.

Now do I think the self referrers are alone in causing this problem? Nope!! As much as I am ashamed to say it, I think the Radiologists are also to blame here. Without a Radiologist to interpret the study a lot of these self referrers would not be able to have these machines. A good number of Radiologists take the approach that “If I don’t read it someone else will”. The problem with that philosophy is that if all Radiologists take that stance then there is ALWAYS someone willing to read the studies and the problem becomes a self perpetuating cycle. Radiologists in hospitals complain that there are too many Doctors doing scans in their offices and not referring patients to hospitals but in the same breath they are interpreting exams for these same doctors. I also think the Radiologists have a responsibility to help regulate the quality of the equipment that is being used in the offices of those self referrers. They should be refusing to read sub-standard exams resulting from sub-standard equipment. I mean geez have you ever seen a Lumbar Spine MRI done on a 250+ lb. patient that has been performed on a 1992 era .3 field MRI scanner? Is that quality patient care? In a word NO !!

In conclusion I think this is a practice that never should have been allowed in the first place but has gotten too big to stop completely now. As I said earlier if they aren’t going to stop it or won’t stop it then they need to regulate it so that patients who don’t understand that they aren’t getting the best possible medical care are protected.

1 comment:

X-Ray Geek said...

Good rant!! I'm in the world of trying to figure out which way to go first for getting better reimbursements for newer, better technologies. These people who have scanners that are older than me are not providing the best service they can and should not be paid what the person with a newest scanner is getting. Welcome to the blog world too!!!