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Scanner Wars

Or, Trust Me, I'm a Doctor

My colleague, Gary Schwitzer, has an interesting post on medical imaging:

Insurers say we're wasting $30B a year on scans.

The local implications are discussed in a recent article from the Strib:

Along a two-mile stretch of France Avenue in Edina, medical providers have installed so many powerful magnetic resonance imaging (MRI) scanners that radiologists joke that anyone driving through with a pacemaker should beware.

Come September, there'll be a new one.

Called Suburban Imaging, it's a joint venture involving one of the biggest radiology groups in the Twin Cities, Suburban Radiologic Consultants; the state's third-largest hospital and clinic group, Fairview Health Services; and 21 physician groups in the area.

The center will offer "the best imaging in the state and equals anything at the Mayo Clinic," said Dr. Owen O'Neill, president of Minnesota Orthopedic Specialists, a partner in the venture.

Its opening is likely to reignite a debate on whether Minnesota has too many diagnostic imaging facilities, encouraging doctors to order unnecessary procedures and pushing up medical costs. It's also likely to raise the ethically thorny question of whether doctors should refer patients to a facility in which they have a financial stake.

"Imaging has been an area of concern for a long time," said Julie Sonier, director of the Minnesota Department of Health's health economics program, which does reviews of major medical investments. "Issues about the concentration in Edina have also been a concern for some time."

In a report to Congress last month, the U.S. Government Accountability Office said Medicare spending on imaging services more than doubled to $14 billion from 2000 to 2006, an average growth rate of 13 percent a year, compared with 8.2 percent for all Medicare physician-billed services.

The GAO report noted a wide discrepancy in use across the country -- with Minnesota right in the middle -- suggesting that not all of it was necessary or appropriate. It also noted that physicians referring patients to their own practices for imaging formed a "major spending driver."

"The race to embrace these new technologies tends to overlook whether we use them correctly," said Dr. Pat Courneya, a medical director at HealthPartners. "Any unnecessary tests make health care more unaffordable for the 47 million uninsured Americans, small businesses, and has implications for Medicare."

Of the new center in Edina, Courneya said: "The investment in more capacity, while not surprising, is a little bit disappointing."

The largest independent chain of imaging centers, the Center for Diagnostic Imaging, was approached more than a year ago to be a partner but declined.

"Our view would be that there are more than enough scanners in the Twin Cities market to handle the demand," said Chief Executive Bob Baumgartner.

The department has further questions on the partnership, Sonier said, including how it's structured. Under a federal law designed to curb physician self-referral, physicians aren't allowed to refer Medicare or Medicaid patients to facilities in which they have a financial relationship. There is an exception for services that are located in the same building, but not all the physician groups involved in the Edina venture are in the same building.

Five years ago, the Health Department deemed the new LifeDiagnostics center in downtown Minneapolis unnecessary. The center was opened by Hennepin Faculty Associates (HFA) at a cost of $2.87 million.

A marketing survey showed that downtown workers wanted a downtown location, HFA said. But the Health Department, noting the five other "quality facilities" close by, and the fact that 85 to 90 percent of patients would be self-referred by HFA physicians, declared the investment "inappropriate."

It ordered Hennepin Faculty Associates to get approval from the department before making any other major spending decisions for five years.

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