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Double CT Chest Scans: For Info Or Income?

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Doing two CT chest scans—one with contrast agent and one without—for the same patient on the same day remains a problem at some hospitals, according to the New York Times.

The Centers for Medicare and Medicaid Services (CMS) puts information on its Hospital Compare Web site about how often hospitals perform various procedures. The figures include only procedures for which Medicare pays, not procedures performed on patients with private or no insurance.

Last year, as we reported at the time, the CMS added information about double CT scans. The numbers were from 2008.

The Times reported on Friday that people who had seen the 2009 numbers (to be released in July) said they were little changed from 2008. It quoted Michael J. Pentecost, MD, a Maryland radiologist and Medicare consultant who also reviews claims for commercial clients, as saying:

When I saw the 2009 numbers, they were the same essentially, and I was disquieted by that.

Some hospitals performed double CT scans for more than 80 percent of their Medicare chest patients. At major university teaching hospitals, the Times reported, the rate is usually less than 1 percent.

The primary concerns are extra radiation exposure and extra cost. The Washington Post and the Kaiser Family Foundation reported that the combined hospital and radiologist Medicare fee for a double CT scan is $403, and the patient would pay an additional $130. A single scan is $362 with contrast dye and $245 without, not counting the payment from the patient in either case.

The Post and Kaiser said payments for privately insured patients, including both the insurance company’s reimbursement and any patient copays, average about $284 for a double scan, $191 for a single scan with dye, and $153 for a single scan without dye.

Radiologists and others quoted in both newspaper reports said double scans are rarely necessary. So why are they being done? The reports suggested several reasons:

  • In rare instances, a double scan might help a doctor distinguish between tangled blood vessels and a tumor.
  • A double scan might show plaque in the arteries or a tear or leak in the aorta.
  • Doctors at small, rural hospitals without radiologists on staff might simply be trying to get as much information about their patients’ problems as possible.
  • Double scans were more common in the late 1990s, before equipment improved and radiation concerns grew, and some doctors are still in the habit.
  • Some doctors or hospitals might simply be trying to make more money. Shocking, I know.

St. John Health System in Tulsa, Oklahoma, double-scanned 80 percent of its Medicare chest patients in 2008. “We recognized in late 2008 and early 2009 those numbers were higher than we needed to be,” said Charles Anderson, the hospital’s president and chief executive.

He said the hospital changed protocols and reduced the rate to about 5 percent:

What that means for us is when a physician orders a scan from a radiology department, the radiologist begins to engage in a conversation with those physicians, talking about what might be a more reasonable and acceptable approach.

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One Response to “Double CT Chest Scans: For Info Or Income?”

  1. Radiology Daily»AlertArchive » Double CT Scans Still A Big Medicare Target on August 15th, 2011 at 10:01 am

    […] refers to the practice of doing two consecutive scans, the second with contrast dye. We last mentioned them in June, when early hints of the latest Medicare report on them began to leak out. Now we discover that the […]