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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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