Paul Levy
First published 6/19/11 on Not Running A Hospital
Dear Mrs. Smith, I am writing to inform you that we exposed your body to an unnecessary level of radiation during your visit to our hospital. Oh, by the way, that was two years ago. We don’t intend to do anything about this for you. Also, we have known about this problem for a long time, and we don’t expect to change our procedures for future patients. Just wanted you to know. Yours in delivering the best health care in the world, Chief of Radiology and CEO. (Jointly signed.)
That’s the essence of this article by Walt Bogdanich and Jo Craven McGinty in the New York Times. Here are excerpts:
Long after questions were first raised about the overuse of powerful CT scans, hundreds of hospitals across the country needlessly exposed patients to radiation by scanning their chests twice on the same day, according to federal records and interviews with researchers.
Double scans expose patients to extra radiation while heaping millions of dollars in extra costs on an already overburdened Medicare program. A single CT scan of the chest is equal to about 350 standard chest X-rays, so two scans are twice that amount.
The pattern was evident in numbers for 2008, and the practice persisted in 2009. Here is a map that you can use to check out your own hospital. Just insert your zip code.
This is transparency at work, right? No. This is transparency that is failing.
The big problem is that the numbers are not current. If numbers are not produced in real time, it permits practitioners to say, “Those are old numbers. We are doing much better now.” That is just a psychological fact of life.
Here’s a quote from another article two weeks ago:
[The government] information reported needs to be a lot more up to date, said Carolyn Clancy, director of the Agency for Healthcare Research and Quality. “We’re not so good at timely transparency,” she said. “We must get to a place where we get data in something like real time.”
Why is it that CMS, the Medicare agency, can’t produce numbers in real time and post them for the world to see on a map like that published today? All Medicare billing is done electronically. All CT scans have a billing code. I know a freshman at MIT who could write the algorithm to extract these figures. You don’t have to wait till a calendar year is over to start compiling numbers.
Isn’t it a matter of public health and medical ethics to publish this kind of data as soon as it is collected? By the way, this is not just a question for Medicare. Why don’t private insurers also publish such figures? What doesn’t each state Medicaid office?
In Massachusetts, the Division of Health Care Finance and Policy now collects an all payer claims data base. Why doesn’t it publish these numbers or allow researchers access to the data so they could do so? Why don’t the local media demand access to it to publish their own stories?
Care And Cost 
I don’t have answers to these questions but can hypothesize – based on my experience in the industry. While such an exercise is not interesting in and of itself, it reveals deeper issues.
First, I may propose privacy issues could be of a concern. Of course, this means HIPAA. Since nobody really understands HIPAA, it is easier to simply not do a task that may be a privacy concern. Each time data is handed off between companies there is a risk of compromise of that data.
Second, billing codes are not accurate? There is a good case of this a few years ago when Beth Israel signed up for Google Health. BI patients ended up with all sorts of erroneous conditions in Google Health. Apparently the transfer of patient data into Google Health was based on billing codes. I believe it is well known that billing codes are an accurate reflection of what a provider needs to do to get reimbursed at the maximum level and not of a patient’s true medical condition.
The issue of billing codes is particularly interesting. Many providers have rooms of people filled to go over tests that have been recently provided and adjust CPT codes to maximize reimbursement. In fact, I just met someone who was going to medical billing school to learn how to do this. I have concluded that this must be significantly lucrative because many large providers have teams of full-time people dedicated to this task.