Health insurance companies are often vilified for denying claims. What if they refused to pay for some of the CT scans being done at a clinic that purchased its own CT scanner and subsequently had a 700% increase in the number of scans ordered? Would the health insurers be held up as the bad guys, for not just paying for the scans? I have to imagine that would be the case, even though it’s likely that a good number of those scans were unnecessary.
Tom Emswiler’s article highlights the obvious problem – the fact that the number of scans jumped by such an astounding amount following the clinic’s acquisition of a scanner – and also details the physical risk posed to patients when unnecessary scans are ordered. When my father was hospitalized a few years ago with serious peritonitis, several CT scans were done. My family – and his doctors – agonized about the radiation exposure from the scans, but he was in a life or death situation at the time, and the risk of the scans seemed worth it. The idea that any doctor would order more scans with personal financial gain in mind is unfathomable to me.
I like Tom’s idea for reimbursing physicians a set amount, regardless of what type of imaging is ordered. Although the flip side there is that an unscrupulous doctor might choose to skimp on care in order to pocket the extra money. I suppose there will always be doctors who put their own financial interests ahead of their patients’ needs – but I like to believe that they are a small minority.
Overall, it makes sense to pay doctors based on patient outcomes and evidence based medicine, rather than paying them for each specific procedure. And after reading the article about the clinic that bought its own CT scanner, I think we need a clear delineation between the people who order expensive testing for patients, and the people who earn a living from performing such testing. If the doctor owns the testing equipment, and also orders the tests, there isn’t a good way to eliminate conflicts of interest. In cases like this, we need health insurance companies that deny claims. But it’s hard to explain to patients that the health insurer is actually the good cop in that circumstance, working to keep health care costs in check. The patients have a relationship with the doctor – not with the health insurance company – and when the doctor says an expensive test is needed, the patients tend to trust the doctor. What they might not know is how much more money the doctor stands to earn if the test is completed.
I found Tom’s article in the Health Wonk Review, hosted last week by Jaan Sidorov at the Disease Management Care Blog.
