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Double CT Scans Still A Big Medicare Target

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Are we really writing about double chest CT scans again? Unfortunately, yes—because hospitals are continuing to do them, despite Medicare guidelines that say the double procedure should be rare.

“Double chest CT scans” 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 new data, released last week on Medicare’s Hospital Compare Web site, show that the percentage of Medicare chest scan patients getting double scans dropped only infinitesimally in 2009, to 5.2 percent from 5.4 percent of patients in 2008.

As Jordan Rau of Kaiser Health News put it:

Medicare has identified the use of both tests on the same patient as a measure of overuse of medical imaging equipment, which is one of many reasons health care costs are growing so quickly.

In other words, at a time when cost-cutting crusaders have turned glittering eyes onto health care and started to sharpen their swords, double chest CT scans constitute a big, fat target.

According to Kaiser, 625 hospitals performed double scans on at least 10 percent of patients using a hospital outpatient facility—one fifth of the 3,121 hospitals whose scan rates Medicare reported. In 2008, the number was 618 hospitals.

In 2009, 88 hospitals gave double scans to at least half their patients. The “leader” was Blue Ridge Regional Hospital in Spruce Pine, North Carolina, at 90.5 percent. The hospital said earlier this year that it uses double scans “out of extra caution, because so many of its patients work in the coal industry,” Kaiser’s Rau reported.

I’ve been to Spruce Pine, which is a pretty little town in western North Carolina near the Blue Ridge Parkway. I didn’t see any signs of a coal industry, though I wasn’t exactly looking for them. The North Carolina State Geological Survey says the most recent year of commercial coal mining in the state was 1953, Of course, there are other aspects to the coal industry besides mining. And historically, there has been considerable mining of other minerals nearby, though again not much in recent years. The area’s major industry lately has been tourism. It strains credulity to believe that 90.5 percent of the hospital’s chest patients work in the coal industry.

Kaiser reports that the hospitals with the next-highest double chest CT scan rates in 2009 were East Texas Medical Center in Fairfield, Texas, at 86 percent; Avoyelles Hospital in Marksville, Louisiana, at 83 percent; Memorial Medical Center of West Michigan in Ludington, Michigan, at 83 percent; Shannon Medical Center in San Angelo, Texas, at 82 percent; and Marion General Hospital in Marion, Indiana, at 81 percent. None of them is in a coal-mining area either.

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