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Re: Study finds "routine" chest x-rays are a waste of time and money
As a licensed/degreed x-ray tech, I used to argue the same issue with the MDs and
billing dept at the hospital I worked at. The overwhelming majority of chest exams
ordered routinely were for liability/insurance reasons, not necessarily medical. I
no longer work in diagnostic x-ray, but unfortunately it appears things haven't
changed. That's the "CYA" world we live in.
-Russ
John Jacobus wrote:
> Saw this through another list server. One can say the
> same about CT screening.
>
> --------------------------------------------------------------------------------
>
>
> Study finds "routine" chest x-rays are a waste of time
> and money
> 11/12/2004
> By: Tracie L. Thompson
>
> As director of cardiothoracic radiology at Emory
> Hospital in Atlanta, Dr. Stefan Tigges felt he was
> wasting hours each day, reading "routine" or
> "screening" chest radiographs that were overwhelmingly
> normal. So he decided to test his anecdotal sense.
>
> His findings, if not surprising, were about as bleak
> as possible. Out of 1,282 routine and screening
> radiographs ordered by Emory's primary care outpatient
> clinic over a one-year period, not one turned up a
> treatable disease (Radiology, November 2004, Vol.
> 233:2, pp. 575-578).
>
> Given that the routine and screening x-rays at Emory
> made up some 34% of the total requested by the primary
> care clinic, it means a substantial percentage of
> their requests "are essentially unnecessary," Tigges
> and his colleagues concluded.
>
> Other studies have confirmed the low yield of routine
> radiography in pediatric patients, preoperative
> patients, veterans, and other groups. However, this
> was the first study to evaluate chest x-rays for
> primary care patients, who are likely to be healthier
> than hospitalized patients.
>
> Out of the 1,282 radiographs, only 15 showed a major
> abnormality. However, 14 of those were false-positives
> that generated only unwarranted anxiety and follow-up
> costs.
>
> And the one patient with a true-positive finding was
> also arguably worse off for the experience, Tigges
> said in an interview with AuntMinnie.com.
>
> The patient endured a partially collapsed lung during
> a follow-up biopsy -- which confirmed that his
> adenopathy was stage I sarcoidosis -- but received no
> treatment for the underlying disease because he was
> asymptomatic.
>
> Overall, "we spent close to $50,000 (on imaging) and
> our yield of treatable diseases was zero," Tigges
> said.
>
> To be exact, the $46,609.49 cost calculated by the
> researchers reflected the Medicare reimbursement of
> $35.05 per two-view radiography for 1,288 original and
> follow-up x-rays, four noncontrast follow-up CTs at
> $283.51 each, and one contrast-enhanced CT at $331.05.
>
> The actual cost to payors was much higher, Tigges
> said, as the clinic charges $105 for chest x-rays in
> "executive physicals" or pre-employment screenings and
> generally receives that fee.
>
> Given the shortage of radiologists, the lost
> opportunities may be far greater than even the dollars
> might indicate.
>
> "To take our time and use most of it up looking at
> studies that are normal and are not going to help
> somebody -- or that may even end up harming them -- is
> a terrible waste of resources," Tigges stated.
>
> "I'd rather focus my efforts where hopefully we could
> do some good," he continued, "for example, looking at
> some cardiac CT scans where I might actually find
> something important that somebody can use to treat
> somebody and improve their outcome."
>
> But changing the ordering habits of primary care
> physicians may be difficult, especially when employers
> require the exam for employees.
>
> "I think when patients or companies want something,
> that it's very hard to influence those types of
> decisions," Tigges acknowledged.
>
> Not that patient preferences don't evolve: Tigges is
> also seeing the routine chest x-rays in executive
> physicals replaced by screening CT requests. "So the
> next step would be to look at the screening CT exams
> and see if they result in a similarly low yield of
> treatable diseases," he said.
>
> In general, "the best thing that we can do is publish
> articles like this," he concluded. "Maybe people will
> look at this and decide that maybe they really don't
> need these x-rays."
>
> By Tracie L. Thompson
> AuntMinnie.com staff writer
> November 12, 2004
>
> Copyright © 2004 AuntMinnie.com
>
> =====
> +++++++++++++++++++
> "That government is the strongest of which every man feels himself a part."
> Thomas Jefferson
>
> -- John
> John Jacobus, MS
> Certified Health Physicist
> e-mail: crispy_bird@yahoo.com
>
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