Why we need payment reform, reason number 36,050

Siemens Brochure: "Capitalize on imaging opportunities in urology"

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:

Chart from Siemens brochure showing increasing profits for performing more CT scans

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.
-Brian Rosman

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1 Response to Why we need payment reform, reason number 36,050

  1. fender says:

    T he point is CT scans studies also save lives, and are a early non invasive study to find cancers at a early treatable stage. More government red tape that retards its use often leads to increase costs of fighting to get approval. sure there may be overuse up to possible 33% but there is already a approval process in place to curtail unnecessary use. . A helpful tool that HCFA could promote is tort reform in Massachusetts, reforms already passed in Texas & Ca have reduced the cost of practicing med & over time reduce the fear of engaging in defensive medicine adding to that 33% cited here.

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