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Data Lead to ‘Double CT Scans’ Questions

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New federal-government data on Medicare patients’ chest and abdominal CT scans, MRI scans for lower back pain, and mammograms have stirred up scrutiny of some hospitals’ practices (as intended) as well as controversy, especially about so-called “double CT scans.”

The data could have big financial implications for health-care providers.

Last week, the U.S. Department of Health and Human Services (HHS) released information from more than 4,600 hospitals on its Hospital Compare Web site, which falls under the aegis of the Centers for Medicare & Medicaid Services (CMS).

“This new update to CMS’s Hospital Compare feature will help patients and their families better compare quality at America’s hospitals,” said HHS Secretary Kathleen Sebelius, as quoted in a department news release. “And thanks to this new update this year, for the first time, Medicare patients can see how efficiently facilities use certain types of imaging equipment and keep them safe from exposure to potentially harmful radiation that may not be necessary.”

Though the information is aimed at consumers, it’s not that easy to find on the site (here’s the download page), nor is it easy to read. However, it’s already having repercussions.

Based on advance word about the data, some hospitals have already started curtailing their use of double CT scans (one with a contrast agent, one without) of the chest and abdomen. CMS says a double scan is recommended for only a small number of conditions. But Health News Florida reported that, according to the data, some Florida hospitals perform the scans on more than half their patients, thus exposing them to a double dose of radiation.

“Certainly some of these scans are unnecessary,” said Barry M. Straube, MD, chief medical officer at CMS.

The Chicago Tribune reported that some Chicago-area hospitals had revised their policies to reduce double scans. Florida hospitals were also examining their procedures. However, some critics complained that the report was a pretty blunt instrument. An Illinois Hospital Association executive, for example, pointed out that the data merely describe how many scans a hospital performed, not whether they were medically justified or influenced by such factors as referrals from other hospitals.

The mammography data also raised questions. For example, Health News Florida reported that the data categorize most Florida hospital outpatient departments as performing either too many mammograms or too few. CMS says hospitals with mammogram recall rates (the percentage of mammography recipients who have a follow-up mammogram or ultrasound within 45 days) of greater than 14 percent may be performing too many follow-ups, and those with rates of less than 8 percent may be performing too few.

“I don’t know where they came up with those numbers,” David Ansell, MD, told the Tribune. Dr. Ansell is chief medical officer at Rush University Medical Center and president of the Metropolitan Chicago Breast Cancer Task Force. He suggested that different ways of evaluating mammography rates, such as determining how many cancers were detected per thousand women screened, would be more meaningful.

He and other critics had better make their cases now. Starting in October 2012, the government plans to use the Hospital Compare data to adjust payments for hospitals.

Related seminar: Thoracic Imaging (brand new)

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One Response to “Data Lead to ‘Double CT Scans’ Questions”

  1. Radiology Daily»AlertArchive » Double CT Chest Scans: For Info Or Income? on June 20th, 2011 at 10:01 am

    […] year, as we reported at the time, the CMS added information about double CT scans. The numbers were from 2008. The 2009 figures are […]