It says multinational suppliers, not Chinese companies, will reap most of that bonanza.

In a news release promoting a new report about the Chinese market, InMedica says shipments of analog X-ray equipment to China will decline at a compound annual growth rate of 14.2 percent over the next five years while the overall Chinese X-ray market increases at a compound annual growth rate of 9.5 percent.

According to the release, the Chinese government, as part of a health-care reform announced in 2009, bought a lot of analog equipment for rural clinics. Many of those clinics are now trying to upgrade to digital.

China’s larger hospitals, in both rural and urban areas, are also going digital. The release says level 3 and large level 2 hospitals are looking to digital X-ray equipment to increase revenue. Once a hospital reaches its effective capacity of 100 daily patient scans per digital radiography (DR) system, it’s ready to buy an additional system.

The release quotes Owen Tang, a Shanghai-based analyst for InMedica, as saying that “almost all new systems purchased by these hospitals will be high-specification flat panel detector-based DR X-ray.” He added:

Unlike other kinds of X-ray equipment, such as mammography and fluoroscopy X-ray, DR equipment can help hospitals increase their revenue stream based on their more frequent use. In fact, return on investment is a critical factor for hospitals making a purchase decision, as current investment from the government is not enough.

Most of this new equipment will come from multinational companies, the release says: “Most level 3 hospitals and big level 2 hospitals [are] only willing to purchase the equipment from nondomestic suppliers.” Chinese manufacturers are concentrating their marketing on county-level hospitals.

No wonder GE Healthcare last year moved the global headquarters of its X-ray business to Beijing.

Related seminar: The Business of Radiology

She had a doctor’s order. She had insurance coverage. She’d had a breast ultrasound. She had a family history of breast cancer and a personal history of breast lumps. She’d had a benign breast lump removed the previous year, after an ultrasound and a mammogram.

But she was 26. Both facilities, she said, told her she was too young for a mammogram.

Katie Schaber responded by e-mailing WKMG-TV Local 6 news in Orlando. The station contacted Libby’s Legacy Breast Cancer Foundation of Orlando, which in turn contacted the Women’s Center for Radiology in Orlando.

In January, Schaber got her 3-D mammogram, which did find an anomaly in her left breast. A follow-up MRI at the Women’s Center found no problem. The center advised Schaber to have another follow-up in six months and a mammogram every year.

Julie Miller, MD, a diagnostic radiologist at the Women’s Center, told Local 6 she has seen girls as young as 17 with breast cancer. Dr. Miller added:

If the patient is young, you would start with an ultrasound to minimize radiation. But you certainly wouldn’t stop at that point just because of her age.

Schaber had gone to Sand Lake Imaging of Orlando in December, armed with her doctor’s prescription for an ultrasound and a mammogram. The clinic did the ultrasound but then declined to do the mammogram.

On her blog, Schaber wrote, “A doctor reviewed my ultrasound and said that, since I was so young and since he didn’t think the scan showed anything too serious, he wouldn’t do a mammogram.”

Sand Lake Imaging said federal law prohibited it from discussing the case.

Next, Schaber tried Florida Hospital Celebration Health of Celebration. Again, she said, she was told the hospital would do an ultrasound but not a mammogram.

Jennifer Roberts, media relations manager for the hospital, told Local 6:

We must abide by our accredited appropriateness criteria approved by the American College of Radiology for diagnostic mammography and breast ultrasound. These criteria recommend that women 29 and under receive an ultrasound and/or provide adequate health history, including previous exams, prior to performing a diagnostic mammogram.

Schaber, a reference librarian at Full Sail University in Winter Park, Florida, has detailed the story on a deeply personal (and award-winning) blog called from IF to when. It focuses on her diagnosis of infertility and its effects on her and her husband’s lives.

Regarding the mammogram issue, she told Local 6, “It seems a little odd to me that I have to keep fighting for something that so many women find uncomfortable. But I think that it is important.”

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Bad news for those who hoped soy isoflavone supplements might protect against breast cancer. See our Facebook page for details.

Related seminar: Breast Imaging and Intervention: A Comprehensive Review (discount and free shipping)

Dense breast tissue may mask tumors on a mammogram and is a risk factor for breast cancer.

Senator Karen Mayne, D-West Valley City, is sponsoring the legislation. According to the Deseret News newspaper of Salt Lake City, she told the Utah Senate Health and Human Services Committee last week:

Today I bring you a bill of love. I don’t want my sisterhood to have any more tragedy, loss of life, loss of income.

The committee unanimously voted to send the legislation to the Senate floor, though one committee member said he had reservations. “I have a general concern in incorporating suggestions into our code,” said Senator Mark Madsen, R-Lehi. He said he also didn’t like legislating the practice of medicine, though he didn’t object to the notification recommendation itself.

The Utah Medical Association supported the amended legislation, said Michelle McOmber, executive vice president:

Part of the reason why we didn’t want a mandate was because health care changes so quickly. We feel good with the amendment.

Mayne said she would have preferred the original bill’s mandate. “We need something that has some teeth,” she said.

McOmber said women can already learn about their breast density from their primary-care physician, who receives a detailed mammogram report from the radiologist. But Senator Luz Robles, D-Salt Lake City, said that wasn’t enough. Women shouldn’t have to ask for that information, she said.

“It’s not because we don’t want to know,” she said. “You expect to get information that is relevant to your health.”

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Happy Monday. To make your Monday even happier, or at least a little more interesting, check out our Facebook page.

Related seminar: Breast & Women’s Imaging Seminar

Don’t bet on it, suggests a Kaiser Health News article. Writer Julie Appleby cites the example of vertebroplasty—the injection of medical cement into compression fractures of the spine in order to relieve pain (at a cost of $5,000 or more). In 2009, two studies said it didn’t work.

The studies, published in the August 6, 2009, issue of the New England Journal of Medicine (click here and here), said vertebroplasty, often done by interventional radiologists, produced no more pain relief than sham injections.

In November 2009, the Society of Interventional Radiologists issued a statement that picked apart the studies and concluded, “We believe it is premature—and possibly incorrect—to conclude that vertebroplasty is no better than a control sham procedure.”

Today, more than two years later, Medicare and most other insurers still cover vertebroplasty.

The Kaiser article also mentions the controversies that followed an October 2011 recommendation by the U.S. Preventive Services Task Force against routine screening for prostate cancer and the Food and Drug Administration’s reversal in November of its approval of Avastin for breast cancer treatment.

Some see such reactions as evidence that financial self-interest, consumer confusion, resistance to change, and other powerful forces will prevail against attempts to reduce health care costs. The article quotes Sean Tunis, MD, founder and director of the nonprofit Center for Medical Technology Policy in Baltimore, concerning the prostate screening and Avastin cases:

If we’re ever going to have a hope of spending less money on medicine, we’re going to have to stop paying for things that don’t work, or hurt people. You could not ask for two more clear examples.

On the other hand, the very fact that the FDA initially approved Avastin before changing its mind demonstrates that there are good reasons for questioning the conclusiveness of research about the effectiveness of a particular procedure. Said Jennifer Jaff, executive director of the Connecticut-based Advocacy for Patients with Chronic Illness:

If you find a medical journal article that says ‘no,’ I can find you one that says ‘yes.’

The PCORI (get used to those initials; you’ll be seeing them a lot) is an independent, nongovernmental board set up by the Patient Protection and Affordable Care Act and funded by a small annual fee on health insurance policies, including Medicare. Its 21-member board represents a broad range of health care stakeholders, including consumers, government agencies, insurers, and makers of drugs and medical devices.

But it’s purely an advisory body, with no power to enforce its recommendations. So it risks becoming an example of what it is trying to eliminate: an expensive procedure that provides no benefit to patients or the health care system.

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How has the American Board of Radiology reacted to last week’s CNN report accusing radiologists of cheating on the ABR qualifying exams? We take a look in today’s Facebook post.

Related seminar: Interventional Radiology Review

The Columbia Daily Tribune newspaper of Columbia, Missouri (home of the university), reported Sunday that:

Multiple sources have told the Tribune that radiology employees, including low-level staff members, recently were instructed by the UM System General Counsel’s office not to delete e-mails or destroy documents, indicating an investigation.

The newspaper also reported that an internal audit published in late 2010 found that University of Missouri Health Care had been providing radiology services to Medicare patients at Women’s and Children’s Hospital in Columbia without proper physician orders. The audit found that 62.5 percent of the cases it reviewed lacked proper authorization.

University of Missouri System attorney Paul McGuffey told the paper, “The fact that physician signatures didn’t accompany orders didn’t necessarily mean services were unnecessary.”

The newspaper reported that a new computerized order entry system seems to have cleared up the problem.

It’s unclear whether the radiology department investigation is related. In fact, it’s not certain that there is an investigation. Neither the university nor officials at the U.S. Department of Justice and the Missouri Department of Health and Human Services would confirm or deny the existence of one—although, as the newspaper suggested, the document-preservation instruction is a pretty strong clue.

Here’s another: the quiet departure late last year of Kenneth Rall, MD, as radiology department chairman. “The announcement of his retirement,” the newspaper reported, “came in a three-sentence blurb tucked between news of a Xerox partnership and a weekly quiz in the Dec. 21 issue of MU Health Care’s ‘InSight’ newsletter.”

Dr. Rall remains a faculty member. Amolak Singh, MD, is interim chairman.

Dr. Rall’s past includes accusations of embezzling money from his radiology partners in the 1980s, the Tribune reported. He faced felony charges of writing checks for bogus Medicaid refunds and then signing the checks over to himself. A few days before the trial, the prosecutor overseeing the case said he had lost the evidence. Dr. Rall wound up with a misdemeanor stealing conviction.

He also testified that he had paid back $928,000 that he had gained from a check-kiting scheme in which he used the “float”—the time lag in communication between banks in those pre–electronic banking days—to inflate one account balance with nonexistent funds from another account.

We’ll keep an eye out for developments.

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On this Martin Luther King Jr. Day holiday in the United States, many health care workers are nevertheless on the job, serving patients, so we’re not taking the day off either. See our latest Facebook post here, and follow us on Twitter here.

Related seminar: National Diagnostic Imaging Symposium

Some have argued for years that health care costs have risen faster than overall inflation because employer- or government-provided health insurance has insulated consumers from the full costs of their health care decisions. Therefore, they don’t bother to be smart shoppers.

Well, in 2010, for the second year in a row, health care costs rose only modestly. The U.S. Centers for Medicare and Medicaid Services (CMS) reported earlier this week that national health care spending grew by 3.9 percent in 2010, to $2.6 trillion. That’s less than the increase in the gross domestic product, which grew by 4.2 percent.

In 2009, health care spending grew by 3.8 percent. As recently as 2007, it grew by 7.6 percent. During some years in the 1980s and 1990s, the percentage increase was in double digits.

The CMS published the 2010 findings in Health Affairs. It attributed a lot of the health care spending slowdown to the recession. Insurance covered less of the costs, either because insurers cut back on coverage or because individuals lost insurance altogether. So people went to doctors or hospitals less often.

But Kaiser Health News interviewed two analysts who said they thought a more fundamental change might be happening. Ana Gupte, a senior analyst at the business research firm Sanford C. Bernstein, said:

The utilization slowdown is at least in part structural and not just cyclically driven by the economy, and the adoption of higher cost-sharing plan designs will result in some level of permanent slowdown in trend.

Tom Miller, resident fellow at the American Enterprise Institute, agreed: “This is more in balance with how we’ve pulled back on consumption sending in other areas. Even this last remaining holdout has begun to buckle, and it’s been enough years to say the basic forces are changing.”

On the other hand, the CMS report also found a shift in health care spending toward the federal government and away from the private sector and state and local governments. From 2007 through 2010, the federal government’s share of U.S. health care spending increased from 23 percent to 29 percent. Private business’s share decreased from 23 percent to 21 percent, and spending by state and local governments decreased from 18 percent to 16 percent of the total.

So maybe the CMS had something to do with controlling health care spending too. We’re not economists, but we are confident in saying this much: the report contains information for all sides in the health care debates to chew on.

Related seminar: Emergency Radiology (all new)

Or maybe both. Or neither.

The “what’s wrong” assessment comes from Ezekiel J. Emanuel, MD, PhD, and Steven D. Pearson, MD, in an op-ed piece last week in the New York Times. Dr. Emanuel, a bioethicist and former White House adviser (Rahm Emanuel, mayor of Chicago and former chief of staff for President Obama, is his brother), is a vice provost and professor at the University of Pennsylvania. Dr. Pearson is president of the Institute for Clinical and Economic Review at the Massachusetts General Hospital’s Institute for Technology Assessment.

Proton beam radiation therapy for cancer can be focused more precisely than other types of radiotherapy, minimizing damage to healthy tissue. However, proton beam machines are tremendously expensive, making the therapy rare and costly.

And, according to Drs. Emanuel and Pearson, unnecessary. They wrote:

The higher price would be worth it if proton beam therapy cured more people or significantly reduced side effects. But there is no evidence showing that this is true, except for a handful of rare pediatric cancers, like brain and spinal cord cancer.

John Noseworthy, M.D., Mayo’s president and CEO, took “serious issue” with Dr. Emanuel and Pearson a couple of days later in a notably calm op-ed piece of his own, this one in the Star Tribune of Minneapolis-St. Paul.

Mayo decided to build the proton beam facilities, he said, only after six years of researching the therapy:

The evidence shows proton beam therapy improves the effectiveness of cancer treatment while sparing surrounding key organs and tissue. The medical effectiveness of proton therapy and its benefit to our patients was the critical factor in our decision to establish these programs.

Dr. Noseworthy summed up the case for such admittedly expensive experiments in a single succinct paragraph: “Mayo Clinic always does what’s best for patients. We will use the proton beam only if it is the best treatment for the right patients. Our program will help to establish this therapy’s appropriate role in medical practice. If there is no benefit to a particular proton therapy for a particular illness, we will discontinue its use, just as Mayo Clinic has for the past 150 years with other technologies and programs too numerous to list.”

That process is one of the ways medical science advances. It also can be really expensive. Drs. Emanuel and Pearson, among others, may contend that we can’t afford it.

But can we afford not to explore what may be significant advances in treatment just because of initially high financial cost?

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Today’s Facebook post? Click here.

Related seminar: Radiology Review

So says a Blooomberg Government study released last week. A Bloomberg news story quoted Peter Gosselin, the study author, as saying:

The industry that was the loudest, most persistent critic of this law, the industry whose analysts and executives predicted it would suffer immensely because of the law, has thrived.

Gosselin is senior health care analyst for Bloomberg Government. He said the insurance industry has thrived because it changed its business model. The five largest insurers have moved away from standard commercial coverage and toward providing services to Medicare and Medicaid patients—running managed-care plans for Medicare and administering benefits for Medicaid, for example.

“Only by substantially reshaping their businesses can they profit,” the study says.

Profit they have been doing. Bloomberg reported that health insurers contributed $86.2 million to the U.S. Chamber of Commerce to oppose the Patient Protection and Affordable Care Act. In the six quarters since the law’s provisions began taking effect, the five largest insurers have seen their averaging operating profit margins increase to 8.24 percent, compared with 6.88 percent for the six quarters immediately preceding the law’s passage.

Those five largest insurers examined in the study are WellPoint, UnitedHealth Group, Aetna, Humana, and Cigna.

The industry itself isn’t so sure those profits will continue. After reading the study, industry spokesman Robert Zirkelbach said:

We remain very concerned that major health care reform provisions that go into effect on January 1, 2014, will raise costs and disrupt coverage for individuals, families, seniors, and small businesses.

Zirkelbach is a spokesman for America’s Health Insurance Plans, the industry’s Washington lobbyist.

And, yeah, we don’t feel too sorry for the insurers either.

Still, Gosselin said the new business model carries risks. The law could be ruled unconstitutional in whole or in part. Congressional opponents could block or refuse to fund certain provisions. State insurance rules could change.

But for now, the industry should be very happy that it wasted $86.2 million.

Related seminar: The Business of Radiology