Skip to main content

Beware the Radiologic 'Incidentaloma'!

Image
By
The last few postings in the Radiology Quality category have detailed the risks of pursing trivial CAT scan abnormalities. Physicians created the term incidentalomas to describe these lesions that were discovered incidentally, or by accident. There is an epidemic of these lesions today as the volume of CAT scanning increases each year. When a scan uncovers an abnormality, the healthy patient is dragged into the medical arena. This unlucky patient may not be healthy for long. These scans are a potent accelerant that fuels the vicious cycle of unnecessary and excessive medical care.

Medicare expenditure for radiologic imaging tests, including CAT scans, is exploding. John Iglehart analyzed this trend in the March 5, 2009 issue of The New England Journal of Medicine.


Medicare Expenditures for Imaging Studies

Year 2000 Annual Expenses: $3.6 billion
Year 2006 Annual Expenses: $7.6 billion


The government capped fees paid for imaging studies performed in out-patient facilities and doctors’ offices in an effort to rein in spiraling costs. This did not work. When reimbursement for these services was frozen, the volume of these imaging studies increased resulting in additional costs to the federal government. Plan B anyone?

Why do individual doctors order so many scans? Most of them have no financial incentive to do so, yet they are quick to pull the CAT scan trigger. On the next posting, I’ll offer some explanations.
Labels:

Comments

  1. Alex SmithApril 8, 2009 at 2:48 PM

    An interesting blog. Found the reference on sermo. I forwarded a link to a few people.

    ReplyDelete
  2. AnonymousApril 9, 2009 at 7:41 PM

    Dr. Kirsch- Hi, it's Jason, very interesting site and valuable info!

    ReplyDelete
  3. AnonymousNovember 11, 2009 at 7:13 PM

    I agree with you completely. I am a working CT Technologist and it sickens me to see the amount of uneeded Cat Scans that are ordered at my workplace a week so the ordering physcian can make a quick buck from the system. A good example of this is ordering a Brain CT on a patient that the family has made a "No Code". What good does a CT do a patient in a comatose state when they have been designated a "No Code". No matter what the scan may or may not discover nothing is going to be done for the patient no matter the outcome of the scan. So why order one in the first place? It only creates another hugh bill that the family or American Taxpayer is going to have to pay and does nothing to help the patient in the end!

    ReplyDelete
  4. emr systemApril 28, 2010 at 5:02 PM

    Hey there, this is an awesome radiology software program. Check it out!
    
Radiology Software
    Let me know what you think.

    ReplyDelete

Post a Comment

Popular posts from this blog

When Should Doctors Retire?

By
I am asked with some regularity whether I am aiming to retire in the near term.  Years ago, I never received such inquiries.  Why now?   Might it be because my coiffure and goatee – although finely-manicured – has long entered the gray area?  Could it be because many other even younger physicians have given up their stethoscopes for lives of leisure? (Hopefully, my inquiring patients are not suspecting me of professional performance lapses!) Interestingly, a nurse in my office recently approached me and asked me sotto voce that she heard I was retiring.    “Interesting,” I remarked.   Since I was unaware of this retirement news, I asked her when would be my last day at work.   I have no idea where this erroneous rumor originated from.   I requested that my nurse-friend contact her flawed intel source and set him or her straight.   Retirement might seem tempting to me as I have so many other interests.   Indeed, reading and studying, two longstanding personal pleasures, could be ext
69 comments
Read more

Should Doctors Wear White Coats?

By
Many professions can be easily identified by their uniforms or state of dress. Consider how easy it is for us to identify a policeman, a judge, a baseball player, a housekeeper, a chef, or a soldier.  There must be a reason why so many professions require a uniform.  Presumably, it is to create team spirit among colleagues and to communicate a message to the clientele.  It certainly doesn’t enhance professional performance.  For instance, do we think if a judge ditches the robe and is wearing jeans and a T-shirt, that he or she cannot issue sage rulings?  If members of a baseball team showed up dressed in comfortable street clothes, would they commit more errors or achieve fewer hits?  The medical profession for most of its existence has had its own uniform.   Male doctors donned a shirt and tie and all doctors wore the iconic white coat.   The stated reason was that this created an aura of professionalism that inspired confidence in patients and their families.   Indeed, even today
43 comments
Read more

The VIP Syndrome Threatens Doctors' Health

By
Over the years, I have treated various medical professionals from physicians to nurses to veterinarians to optometrists and to occasional medical residents in training. Are these folks different from other patients?  Are there specific challenges treating folks who have a deep knowledge of the medical profession?   Are their unique risks to be wary of when the patient is a medical professional? First, it’s still a running joke in the profession that if a medical student develops an ordinary symptom, then he worries that he has a horrible disease.  This is because the student’s experience in the hospital and the required reading are predominantly devoted to serious illnesses.  So, if the student develops some constipation, for example, he may fear that he has a bowel blockage, similar to one of his patients on the ward.. More experienced medical professionals may also bring above average anxiety to the office visit.  Physicians, after all, are members of the human species.  A pulmon
8 comments
Read more