Saturday, June 18, 2011

Rads are good for you. Take twice as many.

Dear Mrs. Smith, I am writing to inform you that we exposed your body to an unnecessary level of radiation during your visit to our hospital. Oh, by the way, that was two years ago. We don't intend to do anything about this for you. Also, we have known about this problem for a long time, and we don't expect to change our procedures for future patients. Just wanted you to know. Yours in delivering the best health care in the world, Chief of Radiology and CEO. (Jointly signed.)

That's the essence of this article by Walt Bogdanich and Jo Craven McGinty in the New York Times. Here are excerpts:

Long after questions were first raised about the overuse of powerful CT scans, hundreds of hospitals across the country needlessly exposed patients to radiation by scanning their chests twice on the same day, according to federal records and interviews with researchers.

Double scans expose patients to extra radiation while heaping millions of dollars in extra costs on an already overburdened Medicare program. A single CT scan of the chest is equal to about 350 standard chest X-rays, so two scans are twice that amount.

The pattern was evident in numbers for 2008, and the practice persisted in 2009. Here is a map that you can use to check out your own hospital. Just insert your zip code.

This is transparency at work, right? No. This is transparency that is failing.

The big problem is that the numbers are not current. If numbers are not produced in real time, it permits practitioners to say, "Those are old numbers. We are doing much better now." That is just a psychological fact of life.

Here's a quote from another article two weeks ago:

[The government] information reported needs to be a lot more up to date, said Carolyn Clancy, director of the Agency for Healthcare Research and Quality. "We're not so good at timely transparency," she said. "We must get to a place where we get data in something like real time."

Why is it that CMS, the Medicare agency, can't produce numbers in real time and post them for the world to see on a map like that published today? All Medicare billing is done electronically. All CT scans have a billing code. I know a freshman at MIT who could write the algorithm to extract these figures. You don't have to wait till a calendar year is over to start compiling numbers.

Isn't it a matter of public health and medical ethics to publish this kind of data as soon as it is collected? By the way, this is not just a question for Medicare. Why don't private insurers also publish such figures? What doesn't each state Medicaid office?

In Massachusetts, the Division of Health Care Finance and Policy now collects an all payer claims data base. Why doesn't it publish these numbers or allow researchers access to the data so they could do so? Why don't the local media demand access to it to publish their own stories?


Michael Pahre said...

Make that 500 freshmen (and women) at MIT.

Some probable reasons it's not done: afraid of what it would show; lack of big-picture assessment by leadership; over-burdened, under-staffed Medicare office.

Anonymous said...

This is a start. You can bet every hospital in the country is right now looking at its rate of double scanning. Too bad we can't publish ALL of these things in the papers. The feds also seem to be more aware of the power of data released for public consumption and manipulation, as indicated by the Health Innovation conference at NIH recently:

But Paul, you have hit on something with the MIT freshmen. Dr. Wachter's blog recently had a post in which he inquired of an old colleague who was starting a new fellowship at Stanford on health care delivery, whether he would take older applicants. The prof's reply:

"No. It's been clearly shown that most of the transformative changes in industries come from the minds of 20-35 year old people."

I imagine this is doubly true for computer technology.

nonlocal MD

Rugby Medical said...

Perhaps the insurance companies are able to charge higher rates for hospitals that order more tests. If this is the case, it's no surprise that they keep this to themselves.

Dave said...

From the private insurer's standpoint of not releasing the data, I would add that fear of lawsuits and smear campaigns by hospitals and physician groups is driving the lack of transparency more than anything else. I know for a fact, having been employed at two of the largest insurers in the nation, that the data is available and even is looked at on a very timely basis. One to two months run out starts to paint a pretty reliable picture of care patterns. Expecting real-time updates, though, is near impossible at this stage of the game due to billing and payment errors, etc.

The one or two month lag in the private sector, however, is a far cry better than the multiple year process that CMS uses with their Medicare data. For those of you who have worked with Medicare data, I'm sure you will agree that the timliness and reliability of releases from CMS is highly suspect. No private sector corporation would ever get away with missing deadlines and glaring errors the way that CMS does. Their selection criteria for choosing consultants to develop tools and data reports is also highly suspect as evidenced by some of the inefficient programming methods I've witnessed as well as the lack of ability for Medicare to meet the same audit standards that they expect of their private sector counterparts in the Medicare Advantage program.