Diagnostic Imaging Centers and Radiology Centers in Florida on Save On Medical

Peeling Away Health Care’s Sticker Shock

We loved this article by Andy Grove on Wired Magazines website from last month. If you didn’t get the chance to read it then, we’re giving you another chance!

Original Article by Andy Grove on 10/16/12 from Wired.com: Peeling Away Health Care’s Sticker Shock

 In the early 1950s, it was nearly impossible to know the value of an automobile. They had prices, yes, but these would differ radically from dealer to dealer, the customer a pawn in the hands of the seller. This all changed in 1958, when US senator Mike Monroney of Oklahoma shepherded a bill through Congress requiring that official pricing information be glued to the window of every new automobile sold in the US. The “Monroney sticker,” as it came to be known, has been with us ever since. It became an effective means of disclosing the manufacturer’s suggested retail price, or MSRP, and a billboard for other data disclosures to the consumer: the car’s fuel economy, its environmental rating, and so on.

The sticker price was one of the triumphs of consumer-rights legislation and has made buying a car an easier—though never altogether easy—experience. What’s more, window stickers made automobile pricing rational and understandable. A customer who knows the base price going in will expect more value coming out. In economic terms, the sticker turned a failed market flummoxed by information asymmetry into something resembling a functioning, price-driven marketplace.

If there is ever an industry in need of a Senator Monroney today, it is health care, in which 1950s-era thinking still rules the day, and irrational and inexplicable pricing is routine. The health care industry plays a gigantic game of Blind Man’s Bluff, keeping patients in the dark while asking them to make life-and-death decisions. The odds that they will make the best choice are negligible and largely depend on chance. Patients need to have data, including costs and their own medical histories, liberated and made freely available for thorough analysis. What health care needs is a window sticker—a transparent, good-faith effort at making prices clear and setting market forces to work.

Exploding Health Care Costs

Since 1987, US health care spending per capita has more than doubled, and the cost borne by patients continues to rise.

Chart design: Luke Shuman
Sources: Archives of Internal Medicine, US Centers for Disease Control and Prevention

How bad is it? Uwe Reinhardt, a leading health care economist, described the pricing of hospital services as “chaos behind a veil of secrecy.” Chaos due to lack of predictability; veil of secrecy because many organizations take a proprietary attitude toward data.

Consider a recent study of the costs of routine appendectomies performed throughout California. Though the procedures were largely identical, the charges varied more than 100-fold—from $1,529 at the cheapest to $182,955 at the most expensive.

What accounted for this bizarre spread? Good question—but efforts to discover the answer turned out to be futile. Although the research highlighted how large the bills for these hospitalizations were, various costs were declared to be trade secrets. The providers (i.e., the hospitals) and insurers involved in the study would not share how much the insurers actually paid for the visits, only what the providers charged. To me, understanding the logic here requires a chain of reasoning that could appear only in Alice in Wonderland. We don’t just need an MSRP sticker—we need a medical Freedom of Information Act!

In business, as time goes on, weak industry participants will try to improve their status, and, of course, incumbents will attempt to protect their positions. Two common ways of imposing or maintaining market power are by forming coalitions or by outright acquisitions, and that’s what has happened in medicine. Consolidation among health care providers has resulted in a number of large organizations becoming even more powerful as they’ve started to use their size and reach. And they’ve wielded this power to keep a lid on some of the information that would make for better health care.

The past several decades have seen major strides in technology of all kinds. Improvements in semiconductors have allowed faster computation and communications, as well as the construction of databases that outdo themselves every year. In many industries, technology development has spurred further improvements in efficiency—a virtuous cycle. In health care, this process is happening at a much slower rate. It has taken decades to complete even relatively simple tasks such as digitizing medical records.

Out-of-Reach Insurance

As the number of uninsured Americans has risen (today more than 15 percent lack coverage), basic care has become out of more people’s reach. This means that costs like additional emergency room visits must be borne by the rest of the population.

Chart design: Luke Shuman
Source: US Census Bureau

What’s more, in most industries technology has served to automate processes and reduce costs. At Intel, we worked to introduce and deploy technologies in a variety of industries. The most difficult to penetrate was the field of medicine. The paradox of health care is that technology has driven costs higher. In fact, half of the increase in medical spending is related to the deployment of new medical technologies.

Part of the problem has been due to well-established prejudices. Consider a recent encounter: A friend of mine, a professor at a major medical school who is in charge of the clinical training of doctors, described a spirited exchange with his students about their choice of a psychoactive drug. There are many such medications. Generic versions apparently show no significant difference in efficacy from newer, branded drugs. An FDA review published in 2009 confirmed this. However, they do show huge differences in cost, with the new medications, by virtue of their patent protection, being much more expensive. Try as he might, my friend could not persuade the residents to prescribe any of the older, less expensive alternatives. The residents insisted that if a new drug was available, even at a much higher price, it would be unethical to not use it.

Investment patterns in health care reinforce this tendency. The largest single spender on medical research and technologies development—more than $30 billion annually—is the National Institutes of Health. Though NIH emphasis has been on new research, not cost, it has made some effort to address the issue. In 2000, a new agency, the National Institute of Biomedical Imaging and Bioengineering, was created to exploit emerging technologies with an eye toward economic benefit. But this effort has been largely marginal and is under constant attack by vested interests: The 2013 fiscal year budget currently circulating in the House of Representatives, for instance, would limit pragmatic funding throughout the NIH.

This cultural bias being baked into policy is not new. In 2009 Congress approved funds aimed at identifying the comparative effectiveness of various treatments. But language opening the door to “comparative cost-effectiveness” was deemed too radical and was cut from the bill. That’s like comparing the performance of a Ferrari to a Kia without knowing which one costs more.

Widely Varying Fees

The price charged for any given medical procedure seems to defy logic. For example, a 2009 study found that the amount billed in nearly 20,000 uncomplicated appendectomy cases in California ranged from less than $2,000 to close to $200,000.

Chart design: Luke Shuman
Sources: Archives of Internal Medicine, US Centers for Disease Control and Prevention

In a transparent health care market, pricing and other patient data can be consolidated and analyzed to yield new insights. A previous head of the Prostate Cancer Foundation, Leslie Michelson, once said that every clinical examination contains the elements of a clinical trial. “Life itself is the greatest clinical trial of them all,” he said. “It’s just a little too big.” But new database tools could speed up the processing of information and allow a clinician to gain useful information from a single patient—in real time. Managing comparisons of data matrices, unthinkable just a few years ago, is entirely practical today. With computers developed for this purpose, correlations could be analyzed, relationships between diseases and treatments studied, and individual treatments generated. In short, the “blinded” patient would benefit from technology, with results much more easily obtained. Meanwhile, every new patient changes the database by adding real-life data elements to the collection. The resulting “digital sticker” would play a major role in bringing order to chaos. It could potentially have just as much impact on the health care business as the MSRP had on the automotive business.

This opportunity will flourish only if a new mindset spreads throughout the health care industry, starting with doctors. The use of new technology, its cost and deployment, all must be taken as seriously as the technology itself. Today it is not. I have particular interest in the nascent discipline of translational medicine, which moves discoveries from the proverbial lab to the bedside. I helped initiate one such effort in this field: a graduate program offered jointly by UC San Francisco and UC Berkeley. The curriculum took off in record time, but disappointingly 91 percent of the students registering for it are engineers and scientists, not doctors. This limits the special value of this effort.

The health care business is about patients. But the patient population has been largely powerless and remains so even as the members of the medical community—hospital chains, nationwide insurers, large employers—have become much more powerful. Over time, the patient—the raison d’être of the health care business—has been reduced to merely another raw material.

This should not last. What technology can do is change the game—change the basis of competition, change what it takes to win in the health care marketplace. In time, some players will compete better than others by making good use of technology. In this competitive environment, patient use of the available pertinent information, with all its benefits, is going to be critical, giving them more economic power. They will likely demand to know more about their various conditions and what their dollars are being spent on. That’s how American consumers have always operated, and I predict they will here as well.

But what they’ll need is transparency in treatment, cost, and institutions—in other words, a digital sticker. Getting that transparency has to be Job One.

Andy Grove, senior adviser to Intel, was the company’s chief executive officer or chair from 1987 until 2005.

Diagnostic Imaging & Radiation Dose Measuring Resource: Scannerside

What do smoke detectors, airports, cell phones, microwaves, atom bombs, your best friend and that cookie you’re holding have in common? If you answered “a very interesting dream where you are Jason Bourne,” then points for creativity, but the correct answer is radiation. It seems just about everywhere you look, your body is being exposed to some amount of radiation, whether it’s man-made, natural or medical. The United States Nuclear Regulatory Commission states that the average American is exposed to about 620 millirem of radiation each year, and that doesn’t include outliers like atom bombs. This isn’t Hiroshima.

It is believed that typically about 96% of a person’s radiation exposure comes from medical procedures, so fortunately you don’t need to be too hung up on your cell phone’ radioactive waves. Pun Intended.

Most patients who are exposed to radiation through medical procedures are receiving those millirem from the following popular diagnostic imaging scans:

Chest X-ray: 10 mrem

Full-body CT: 1,000-mrem

CT of the chest: 700 mrem

CT of the head: 200 mrem

Dental X-ray: 1.5 mrem

X-ray of hand/foot: 0.5 mrem

Of course as patient-consumers, which the health care industry has started to refer to you as with the dawn of better patient education, you should be aware of these things, especially in light of the attention your diagnostic imaging providers are paying towards radiation.  Since 2011, ensuring that hospitals and outpatient imaging facilities are appropriately measuring radiation dose has been a top priority.  It was found that a number of top hospitals in the country were not doing a satisfactory job of tracking dose and reporting on patient dose. Since then, providers have been essentially scrambling to find a way to successfully and efficiently manage the process of radiation dose tracking and reporting.

The search is over my friends. Scannerside, a radiation dose tracking system developed by radiologists Dr. William Moore and Dr. Ronak Talati, has become available to hospitals and radiology departments across the country. Not only is it an especially accurate system for measuring dose, but it also allows for simple patient reporting. Most importantly, it does not require the capital necessary to implement the program into practice protocols, which has been typical of similar systems in the past. Additionally it takes little to no implementation time before staff can utilize Scannerside. This is because it is cloud-based and easily integrates with all EHR, EMR and PACS systems.

 

Learn more about Scannerside and how it is transforming radiation dose tracking and patient experiences by reviewing the white papers and slideshows on their website.

Atlantic Health Solutions Named Approved Distributor of Right Dose INC, D.B.A Scannerside

Atlantic Health Solutions is now an approved distributer of Scannerside, a program that provides and tracks patients’ and radiology providers’ radiation dose from CT scans and angiography procedures.

 

The revolutionary Scannerside system, which allows radiology facilities and hospital departments to track radiation dose more accurately and efficiently, has made a huge splash in the New York market. The ease with which the cloud-based system is integrated into radiology practice protocols helps staff members monitor radiation dose, provide accurate reporting and give patients accurate print-outs of their radiation dose. 

In light of the challenges associated with decreasing dose and radiologists across the country looking for a way to fix to the issue of poor radiation dose tracking, Scannerside is a great solution. Atlantic Health Solutions, industry leading marketing and management provider to radiology and radiation oncology practices, now is an approved vendor of the system and can bring it to your practice today.

Chris Christenberry, Atlantic Health Solution’s CEO said, “This new service adds another layer to the quality management services that Atlantic Health Solutions provides to radiology practices and hospitals and we are pleased to be working with Scannerside to serve more patients and practices.”

Scannerside is a data analysis program that provides and tracks patients’ and radiology providers’ radiation dose from CT scans and angiography procedures.  After their CT procedures, patients receive print-out dose cards, outlining their amount of radiation and the radiology provider is able to keep track of total patient dose administered at their facility.

Real-time data analytics and management capabilities are the proven benefits of utilizing Scannerside at both outpatient diagnostic imaging centers and hospital systems, alike.  Atlantic Health Solutions is dedicated to providing the very best management services to their clients across the country. Christenberry commented “working with Scannerside means that Atlantic Health Solutions will be able to better serve their clients and future clients by providing access to such a user friendly, reliable and necessary program.”

Health Care Costs Not Related to Medical Imaging Scans

An article posted by McKesson discussed issue medical imaging cost have on health care expenditures of late. Some say over-utilization has led to higher health care spending, but it could also be argued that medical spending on health care procedures like MRIs, CT scans and Mammograms could be the first line of defense against illness down the line. We agree that it can stop patients and providers from performing more expensive procedures in the future, when a precautionary scan would have caught a problem earlier.

This is especially true in cases where imaging procedures such as mammograms for breast cancer screenings lead to early breast cancer diagnosis. Recent studies for breast imaging have shown that the amount of lives saved from early detection thanks to annual, regular mammogram imaging outweighs the risks and negative aspects associated with “over-scanning.”

The new study conducted by Steven Duffy, a professor of cancer screening at Queen Mary, University of London, indicates that getting a mammogram every two years outweighs any potential radiation dangers of mammograms.  This is especially true for women between the ages of 50 and 70.  The study, published in the September 13th issue of The Journal of Medical Screening states that for every 1,000 women 4 were over-diagnosed.  The details of the over-diagnosis were that 170 women would have had one recall with a noninvasive test that showed up negative.  However, out of 1,000 women who participated in regular mammograms between the ages of 50-70 with no symptoms of breast cancer, it was found that 9 lives were saved as a result of early detection.

Duffy’s findings prove that over-diagnosis should not be women’s primary concern when it comes to breast cancer screenings, in the same way that preventative scans for other medical reasons should not be a main focal point. The fact is, many patients in the United States are uninsured or underinsured and are forced to go without necessary medical procedures already. We want to empower patients, making them advocates for their own health, especially in cases such as mammogram screenings. There are so many more components of health care spending that could be cut or reallocated to allow for less economic spending, but medical imaging is not the problem.