Hospitals Nationwide Unnecessarily Perform Double CT Scans
Hundreds of hospitals nationwide routinely perform two chest CT scans on a single patient, needlessly exposing them to double doses of radiation and driving up costs, according to a review of Medicare data, the New York Times reports (Bogdanich/Craven McGinty, New York Times, 6/17).
Patients who receive a double CT scan undergo a contrast and a noncontrast CT scan in succession (Appleby/Rau, Kaiser Health News/Washington Post, 6/18). Although most radiologists say nearly all chest issues can be accurately diagnosed with only one scan, 2008 Medicare data show that some hospitals performed double scans on chest patients more than 80% of the time.
According to the Times, a single CT chest scan exposes a patient to 350 times the radiation of a standard chest X-ray (New York Times, 6/17).
Specifically, Medicare data show that 76,781 chest patients, or 5.4%, received double CT scans in 2008. While most hospitals administered them sparinglyâ"a median of 2% of Medicare patients received two scansâ"618 hospitals performed double scans on at least 10% of Medicare chest patients, and 94 of those hospitals performed double scans on at least 50% of Medicare chest patients (Kaiser Health News/Washington Post, 6/18).
Experts note that double scanning also is common for privately insured patients (New York Times, 6/17). Although the number of overall non-Medicare patients who receive double scans is unknown, HealthPartners, a not-for-profit Minnesota HMO, reports that 7% of its chest patients received double scans in 2010 (Kaiser Health News/Washington Post, 6/18).
Explaining the High Rates
Officials at facilities with high double scan rates say the extra scans provide physicians with more information. One such official notes that small rural hospitals may perform two scans to expedite a diagnosis and quickly determine if a patient needs to be transferred to a facility with a wider range of medical services (New York Times, 6/17).
However, other experts suggest that financial incentives drive physicians to order two scans. The hospital and radiologist fees for double scanning a Medicare patient total $403, compared with $245 for a noncontrast CT and $362 for a contrast CT, KHN/Post reports (Kaiser Health News/Washington Post, 6/18).
CMS Outlines Methods To Curb Double Scanning
CMS is urging hospitals to limit double scanning as a way to curb health costs and potential cancer risks, the Times reports. According to the director of the agency's Quality Measurement and Health Assessment Group, "hospitals certainly have the ability to put in policies and to monitor what's happening."
For example, one Tulsa hospital successfully reduced double scanning from about 80% in 2008 to roughly 5% in 2011 by changing scanning protocols. Radiologists at the hospital now discuss all scan requests with physicians to determine the most reasonable approach (New York Times, 6/17).This is part of the California Healthline Daily Edition, a summary of health policy coverage from major news organizations. Sign up for an email subscription.