We were working on a post about why we spend millions on cancer care, yet little on cancer prevention, and the pressures on physicians to increase costs at the expense of patients’ needs, when we came across this post by public health expert Harold Pollack, which linked to this brochure (pdf), from Siemens, a medical device manufacturer.
The brochure urges urologists to invest in the latest CT scanners that can “significantly improve the overall bottom line of your practice,” and “maximize your return on investment.” “In office CT can be a significant new source of practice revenue. Let us show you how.” the brochure gushes. The brochure includes a helpful chart so doctors can figure out their monthly and 5-year return on investment. It turns out, the more scans you do, the more you make:
This encapsulates much of why the fee-for-service payment structure has all the wrong incentives. A doctor’s take-home pay is not based on how well he or she protects health or treats disease, but on how many billable procedures and services are performed. Perform 10 scans a day, and you pocket $36,050 each month. Sweet. But there’s no reimbursement at all for spending time with a patient, counseling about disease prevention, talking to family members, or discussing treatment options.
We have long been concerned about the dangers of unbridled CT scans. Radiation from CT scans causes 29,000 cancer cases each year in the U.S., and a full third of them are totally unnecessary (see this post for more details). We’re working with Representative Stephen Kulik on legislation that will require DPH to make suggestions for reducing CT scan use. But this example is not tied to Siemens, or CT scans, or even medical technology. It’s the underlying payment system that drives up our costs, and gives us less of what we need, and more of what’s profitable. That’s what has got to change.