Unnecessary Care?

December 15, 2009
Jeff Kaplan

Read a prime example of costly, possibly harmful procedures where well over half are deemed unnecessary...

Here's a prime example of costly, possibly harmful procedures where well over half are deemed unnecessary....

A University of Wisconsin-Madison team, led by Dr. Kristie Guite reviewed 978 abdominal and pelvic CT scans done on 500 patients. They used American College of Radiology guidelines to determine whether these studies were indicated or, in fact, appropriate.

52% of the patients "receiving abdominal CT scans, an advanced type of X-ray, got them for tests they did not need, exposing them to excess radiation that could raise the long-term risk of cancer"--i.e., the average excess radiation dose per patient was 11.3 millisieverts, about the equivalent of 113 chest X-rays.

At the dose seen in the study, one in 1,000 patients could get a radiation-induced cancer," Guite said adding that "This could lead to up to 23,000 radiation-induced cancers per year" Also, "Many of the scans they looked at involved the use of a contrast agent," implying that some "many institutions may be doing the extra studies for good measure, or because their machines are automatically set to do them..... But .... it was possible some centers were doing the extra scans because they may get paid more for them."

Steenhuysen J. "Abdominal CT Scans Overused - U.S. Study." Reuters, Nov 30, 2009.

From: Anonymous (A National HMO Physician Executive)Date: 12/16/2009Subject: Please provide me an Insurer's perspective on efficiency and caring in this context

OK - how about this sequence of events:

1/4 of all health care cost occurs in the last year of life.

Given a terminal illness diagnosis, when surveyed, 75% say they'd elect Hospice care.

We note, 27% of all deaths in the U.S. take place in a Hospice setting (and this is double from12 years ago).

Also, when Hospice is elected, acute days are 85% less than when it is not.

What are we doing and why?

From an insurer's perspective, this is just a one of many examples, albeit more dramatic, of what happens in the real world.

Why do they do so much less in Western Europe, with the same or better results?

Does one really need that MRI for his or her back pain? What will they do with it?