If you’re on Medicare, beware of this medical scam that puts you at unnecessary risk
Deep in your heart
It’s pretty amazing when you think about it. With just a few button pushes, a radiologist can produce a multidimensional view of your heart — a remarkably accurate diagnosis tool.
But if you don’t have any clear symptoms of artery problems or heart disease, is it reasonable to use a CT scan as a precaution?
Last year I told you about a Johns Hopkins study that compared outcomes in about 1,000 people who received a scan, and 1,000 who didn’t. A year and a half after the scans, subjects in the CT scan group had been given more heart procedures, more follow-up tests, and more medications (primarily statins and aspirin) than subjects who didn’t get scanned.
And what was the benefit of all that extra treatment?
Nothing.
Rates of heart attacks, heart disease deaths and other cardiac events were the same in both groups.
Obviously, if there’s no clear heart risk, there’s no reason to scan. And yet, the overuse of CT scans is fairly common. And here’s the scandal that’s quietly flying under the radar: In many cases, this overuse is not driven by concern for patients, it’s driven by profits.
Scan scam
Imagine if your doctor told you he needed to take 700 X-rays of your chest.
Even the most timid, trusting patient would probably speak up with two questions:
1) Are 700 X-rays really necessary?
2) Won’t that expose me to a dangerous amount of radiation?
The answers, of course, are 1) No, and 2) Absolutely!
But if your doctor approached it another way and just told you he needed to do a double CT scan of your chest — one using an iodine contrast to examine blood flow and one scan without the iodine — you might simply go along with the plan. After all, he’s the doctor. He knows best.
That’s exactly what’s happening with thousands of patients every year.
Now here’s the disturbing reality:
* A double CT scan is almost never necessary (the rate of double scans compared to single scans at major university teaching hospitals is about one percent)
* Medicare pays out millions of dollars every year to cover unnecessary second scans
* Two CT scans deliver the same amount of radiation as 700 standard chest X-rays
* Exposing patients to that level of radiation is very dangerous, but doing it unnecessarily is wildly unethical
In recent years, the Center for Medicare and Medicaid Services (CMS) has taken steps to alert hospitals, radiologists, and doctors to the high rates of unnecessary double CT scans.
Some hospitals that were previously out of control have brought their double scan rates down to the level of five percent or lower, which is where they should be. But according to the New York Times, a number of hospitals continue to have rates as high as 80 percent. And in 2009, more than 200 hospitals used double scans on at least 30 percent of Medicare outpatients.
Judging from the Times article, these hospitals aren’t held accountable in any way. Apparently the only repercussion is a poor report from the annual CMS review, which stings just a little bit less than a mild slap on the wrist.
As is so often the case, we can’t wait for Health and Human Services or some other oversight organization to step in and take control. Please forward this e-mail to anyone you know who relies on Medicare and has cardiovascular problems that might require a CT scan.
And most importantly, never be afraid to ask detailed questions about any medical procedure or test that seems odd or fishy. Trust your intuition and get answers before agreeing to anything — especially if radiation is involved.
Sources:
“Impact of Coronary Computed Tomographic Angiography Results on Patient and Physician Behavior in a Low-Risk Population” Archives of Internal Medicine, Published online ahead of print 5/23/11, archinte.ama-assn.org
“Some heart screenings may do more harm than good” Monifa Thomas, Chicago Sun Times, 6/25/11, suntimes.com
“Medicare Claims Show Overuse for CT Scanning” Walt Bogdanich and Jo Craven McGinty, New York Times, 6/17/11, nytimes.com
