The explosion in the use of diagnostic imaging - particularly high-tech, high cost scans such as CT, MRI and PET scans - has led to many questons about appropriateness of all these scans. I've blogged about some of these concerns as recently as last week.
In Minnesota, the Medica health plan claims that 15 to 20 percent of the scans it pays for are not appropriate for the condition being treated, according to a story in the Star Tribune.
But the real news the paper reports is that three insurers have begun (or will soon) to require third-party review by an outside evaluator of all requests for such high tech scans. And doctors don't like it.
The paper reports: "In a letter obtained by the Star Tribune, the 11,000-member Minnesota Medical Association (MMA) asserts that the new third-party consultation places a burden on patients and clinics alike and will 'interfere with the patient-physician relationship. Physicians throughout Minnesota, whether practicing in urban or rural, primary care or specialty, large or small group practices, along with health care leaders in the community, agree this is the wrong direction to take,' said the letter."
This is an important issue.
Why, for example are there something like 20 CT or MRI machines within a two-mile radius of one medical center in metropolitan Minneapolis?
Who says all of those machines are needed? Who knows if all the scans are warranted? And who pays when those machines go unused?
Some may claim that insurers are denying appropriate care, but I think they're asking legitimate questions that may answer some of the questions above.
Posted by schwitz at February 2, 2007 08:05 AM | TrackBackThe reimbursement rules just changed this year so that freestanding clinics were not reimbursed more than the big hospital organizations. The money involved with these free standing locations had quite a bit to do with how quickly they popped up. Now, the upper hand is in the bigger organizations's hand, not the free standing imaging clinics.
Posted by: Anonymous at February 18, 2007 10:29 AMPatients probably pay, or goverment (read taxpayer). Otherwise would anybody even bother to build the machines? Look for example at this article at PUBmed:
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=8551814&dopt=Abstract