Posted 4/9/12 on the Disease Management Care Blog
Remember this article on screening for lung cancer?
More than 54,000 former and current tobacco users who looked like they were free of cancer were randomly assigned to a yearly cheapo chest x-ray vs. a yearly pricey low-radiation-dose CAT scan. Over 5 to 7 years of follow-up, the CAT scan was better at picking up early lung cancer (119 cases) which translated into a small but statistically significant survival advantage of 62 lives saved per 100,000 patient years.
Does this mean that Medicare, Medicaid and all commercial insurers should “cover” a baseline and yearly follow-up screening CAT scan for tobacco smokers at risk for lung cancer? According to actuary Bruce Pyenson and colleagues writing in the latest issue of Health Affairs, the answer may be yes.
The Disease Management Care Blog thinks the answer may still be no.
Is it being a heartless curmudgeon? Read on and decide for yourself…….
Continue reading “Should Health Insurers Cover Lung Cancer Screening with Low Dose CAT Scans?”
Posted 1/18/12 on Common Sense Family Doctor
The urban public hospital where I completed most of my training as a medical student had a single CT scanner. To ensure that this precious resource was put to effective use, any physician ordering a non-emergent CT scan was required to personally present the patient’s case to the on-call Radiology fellow and explain how the result of the scan would potentially change management. Since my attending surgeons were usually too busy to trudge down to the Radiology suite, they deputized their residents to do so, and most of the time my residents passed this thankless task down to the students. Thus, my classmates and I learned early on the difference between appropriate and inappropriate reasons for ordering CT scans.
Continue reading “Curbing Overuse of CT Scans – And Other Interventions”
So what is the most significant health care technology implemented in health care in the last thirty years? The DaVinci robotic surgery system? Proton Therapy perhaps? No, not those. We want diagnostic, not treatment, technologies.
The answer is advanced imaging. Thirty years ago, a patient presented with non-specific abdominal pain. How did we diagnose it? Palpate, lab tests, order an x-ray. No conclusive results? Send them off to surgery.
Continue reading “Will The Value Of Advanced Imaging Prevail?”