Stark Reality
Rep. Pete Stark, one of the sponsors of the new health care legislation, has nearly single-handedly increased health care costs. How can I say that? Here is a small town example that you can multiply across the country if you so desire.
In the early 1980s, magnetic resonance imaging (MRI or NMR as it was known then) was the hot new diagnostic technology. It appeared to be a revolutionary step in evaluating brain and spine disease and evolutionary in other areas as well. The equipment was expensive and no one had a lock on interpretation of studies, as no physicians in practice, including radiologists, had learned this technology in training.
Medical centers that had been early adopters became the places to obtain training and training was available for any physician who had enough passion and likely patients.
MRI Part 1: It enters the private diagnostic arena Free Market Style
A group of neurologists, neurosurgeons and orthopedists banded together and purchased a MRI scanner. For several years, this one unit supplied the majority of the needs of the neuroscience community for a population of 3 million. How could one scanner satisfy such a large group of physicians and their patients? All studies had to be interpreted by the ordering physician (who had to demonstrate competence before being allowed to interpret studies). This meant that anytime a test was ordered, it would impart a commitment of time to interpret the study. With finite physician time came a careful choosing of appropriate patients. The machine ran 24/7, maximizing the investment and minimizing overhead. Even with continuous operation, there was a limit to the available time slots, no one could be "piggy" and monopolize the unit.
MRI Part 2: A piece of the action
In my small community, the local hospital wanted to get involved in the MRI business. It put together a coalition of local physicians to invest with the hospital, with the images being interpreted by the local radiologists. The plan was for the local physicians to refer their patients to this unit and to make some return on investment, while the radiologists would earn by interpreting studies. Now, those who just wanted to turn a profit were investors and there was no physician time limit on the number of scans that could be ordered, as MRI interpretation was separated from other (evaluation and management) physician services. More studies could be performed per population. But, there still was a control: the desire for profitability. The goal remained to maximize profits by efficient operation.
MRI Part 3: Stark
The Stark law made physician co-ownership (joint venture) illegal. The practicing physicians had to withdraw from the MRI investment which now became totally owned by the hospital and run by the radiologists. The theory was that physicians were sending patients for MRI scans to pad their pockets and that now, under Stark, we would see a reduction in MRI studies and cost savings. What happened? Two nearby hospitals now had no reason not to have their own MRI machines, so each acquired their own. Each hospital had its own independent radiology group. One purchased the original scanner and two others built their own free standing MRIs. Finally, a local university established a local outreach clinic in the area and installed its own MRI. One MRI was now replaced by 6. With so many MRI machines in the area, it became not who should get a MRI, but who should NOT. Supply was essentially unlimited for this small community, leading to increased utilization for even marginal indications. As even marginal indications occasionally produced unexpected findings (and as failure to perform a MRI became a legal issue, especially where access was easy) the demand for scans kept up with the supply. To an extent. The scanners run 1 shift/day. Some only run 5 days/wk. So, we have more scanners run less efficiently and more scans for less concrete reasons.
MRI Part 4
The final step is currently underway in Pennsylvania (DocBrain's home) but is already in effect elsewhere. It is to bar any non-radiologist from interpreting a MRI study. This would finally eliminate any time constraint control on MRI studies. MRIs can be interpreted by telemedicine, eliminating even the minimal friction of local radiologist time constraints.
The well-intended government and Pete Stark have done exactly the opposite of what would have kept health care costs down. They took control of a diagnostic procedure away from those who know how best to use it because of fear of profit. The unintended consequence was to increase number of scanners, number of scans, and the overall cost of health care in my small community by a factor of at least 6.
And what about the entire area that was covered by that first neuroscience scanner? There are now 160 MRI scanners within those physician's practice areas.
And you trust Pete Stark to give you affordable health care?
In the early 1980s, magnetic resonance imaging (MRI or NMR as it was known then) was the hot new diagnostic technology. It appeared to be a revolutionary step in evaluating brain and spine disease and evolutionary in other areas as well. The equipment was expensive and no one had a lock on interpretation of studies, as no physicians in practice, including radiologists, had learned this technology in training.
Medical centers that had been early adopters became the places to obtain training and training was available for any physician who had enough passion and likely patients.
MRI Part 1: It enters the private diagnostic arena Free Market Style
A group of neurologists, neurosurgeons and orthopedists banded together and purchased a MRI scanner. For several years, this one unit supplied the majority of the needs of the neuroscience community for a population of 3 million. How could one scanner satisfy such a large group of physicians and their patients? All studies had to be interpreted by the ordering physician (who had to demonstrate competence before being allowed to interpret studies). This meant that anytime a test was ordered, it would impart a commitment of time to interpret the study. With finite physician time came a careful choosing of appropriate patients. The machine ran 24/7, maximizing the investment and minimizing overhead. Even with continuous operation, there was a limit to the available time slots, no one could be "piggy" and monopolize the unit.
MRI Part 2: A piece of the action
In my small community, the local hospital wanted to get involved in the MRI business. It put together a coalition of local physicians to invest with the hospital, with the images being interpreted by the local radiologists. The plan was for the local physicians to refer their patients to this unit and to make some return on investment, while the radiologists would earn by interpreting studies. Now, those who just wanted to turn a profit were investors and there was no physician time limit on the number of scans that could be ordered, as MRI interpretation was separated from other (evaluation and management) physician services. More studies could be performed per population. But, there still was a control: the desire for profitability. The goal remained to maximize profits by efficient operation.
MRI Part 3: Stark
The Stark law made physician co-ownership (joint venture) illegal. The practicing physicians had to withdraw from the MRI investment which now became totally owned by the hospital and run by the radiologists. The theory was that physicians were sending patients for MRI scans to pad their pockets and that now, under Stark, we would see a reduction in MRI studies and cost savings. What happened? Two nearby hospitals now had no reason not to have their own MRI machines, so each acquired their own. Each hospital had its own independent radiology group. One purchased the original scanner and two others built their own free standing MRIs. Finally, a local university established a local outreach clinic in the area and installed its own MRI. One MRI was now replaced by 6. With so many MRI machines in the area, it became not who should get a MRI, but who should NOT. Supply was essentially unlimited for this small community, leading to increased utilization for even marginal indications. As even marginal indications occasionally produced unexpected findings (and as failure to perform a MRI became a legal issue, especially where access was easy) the demand for scans kept up with the supply. To an extent. The scanners run 1 shift/day. Some only run 5 days/wk. So, we have more scanners run less efficiently and more scans for less concrete reasons.
MRI Part 4
The final step is currently underway in Pennsylvania (DocBrain's home) but is already in effect elsewhere. It is to bar any non-radiologist from interpreting a MRI study. This would finally eliminate any time constraint control on MRI studies. MRIs can be interpreted by telemedicine, eliminating even the minimal friction of local radiologist time constraints.
The well-intended government and Pete Stark have done exactly the opposite of what would have kept health care costs down. They took control of a diagnostic procedure away from those who know how best to use it because of fear of profit. The unintended consequence was to increase number of scanners, number of scans, and the overall cost of health care in my small community by a factor of at least 6.
And what about the entire area that was covered by that first neuroscience scanner? There are now 160 MRI scanners within those physician's practice areas.
And you trust Pete Stark to give you affordable health care?
posted by DocBrain at
2:09 PM
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