Curtailing exceptionally high emergency care costs can start with eliminating several types of scans offered patients, according to a new medical policy report, which lists five unnecessary imaging procedures.
The U.S. medical profession has been searching for ways to make deep trims in the cost of health care. Although the Affordable Care Act is making health care accessible to more people, experts say, the cost of that care continues to rise at unsustainable rates.
Dr. Jeremiah Schuur and colleagues at Brigham and Women's Hospital in Boston say the number of tests, treatments and hospitalizations generated by hospital emergency departments is extraordinarily expensive. The Boston team reached their conclusions by assembling emergency care specialists and polling them on procedures best left undone.
"Emergency medicine is under immense pressure to improve the value of health-care services delivered," Schuur said in a statement. "Developing and addressing a top-five list is a first step to addressing the critical issue of the value of emergency care."
Dazzling technology, Schuur found in the analysis, is a major driver of costs and several tests that patients are frequently offered can be accomplished through less expensive but equally effective procedures, his research concluded. These tests include several types of CT scans and magnetic resonance imaging such as:
CT scans of the cervical spine for trauma patients who do not meet high-risk criteria.
CT scans to diagnose pulmonary embolism (blockage of an artery in the lung usually by a blood clot). The report recommends first determining a patient's risk for pulmonary embolism.
MRI of the lumbar spine for patients with lower back pain without high-risk features.
CT of the head for patients with mild traumatic head injury who do not meet high-risk criteria.
Anticoagulation blood tests for patients without hemorrhage or suspected clotting disorder.
Dr. Victor Scarmato, chairman of radiology at Nassau University Medical Center, said the recommendations, which were published in the journal Internal Medicine, are not unrealistic. But more than money should be considered, he said.
"There is an economic issue and there is also the radiation dose to consider," Scarmato said, referring to CT scans.
"We don't want to give anyone a radiation dose unless the benefit of that dose outweighs the use of the scan."
Dr. Michael Poon, director of Stony Brook University Hospital's advanced imaging program, said he agrees with Schuur's list of unneeded scans, including the recommendation not to order a scan for a blood clot in an artery of the lung.
"There are other tests that can be done first before going straight to CT. That is overuse," Poon said.
Poon conducted one of the country's first studies to show how the use of CT scans in emergency cardiac cases can reduce costs for hospitals.
A scan, he said, costs patients or their insurers about $700. But each unnecessary admission costs the hospital about $5,000.
For every 250 patients who do not have to be admitted, the hospital saves about $1.25 million, Poon said.
By implementing Poon's plan of scanning patients with chest pain, Stony Brook doctors were better able to treat patients and hospitalize fewer of them, according to his own published analysis.Poon said the five scans Schuur and colleagues list "are low hanging fruit," and that he would not order scans for any of the conditions Schuur outlined.
Schuur's analysis, however is not the first to suggest that emergency room doctors avoid CT scans of the lower back and even of the head in instances of mild trauma.
Physicians from 17 leading specialty organizations last year produced a similar list making similar recommendations. While the notion of avoiding scans for lower back pain are widely accepted, the recommendation of avoiding scans for head trauma are not.
"That's a double-edged sword," Dr. Elizabeth Trinidad of Neurological Surgery P.C. told Newsday.
"It used to be a big controversy whether we do a CT scan or observe them overnight. But because of the current medical-legal environment, we now do both."