Wednesday, May 4, 2011

You Pay For It--And Your Doctor May Be Making Money On It

Here we show the difference between two types of MRI. One is the industry standard, high field 1.5 Tesla MRI that has superb image quality. This is the larger image on the top. The second, middle image is from a low field 0.3 Tesla MRI that has inferior image quality. There are several technical problems with this images. This is a low field magnet that does not have optimized imaging protocols.

The bottom image, for comparison, is also a low field magnet image, but it has optimized protocols with closely followed quality assurance protocols.

None of these images has been altered except to remove confidential patient information. These are truly 'what you see is what you get' images from these different scanners.

Unfortunately, even though the image quality and, therefore, the ability to make an accurate diagnosis is impaired on a low field MR, they cost the same. Insurance companies, Medicare, Medicaid, etc, all pay the same. As a result, your copay or the amount that YOU have to pay is the same. You don't just get a discount because the image quality is suboptimal.

While this all seems unfair--and it is--what you may not know is that that low field MRI that your doctor is sending you to may be sending your doctor a check every month. For example, the image above is from a facility in Tulsa that is owned by physicians. They send their patients there not because of the image quality but, one can easily argue, because they are shareholders in the company that owns the MRI. However, I have had a physician investor at this magnet tell me that their image quality is better.

This was doctor who has no training in imaging, physics or image quality. You tell me what you think--which is clearer, more easy to see, the image on the top or the image on the bottom. Then tell me--do you think that the physician is more concerned with getting a check from his imaging center or the quality of the MRI that his patient receives? This type of unethical behavior gives the good doctors a bad name--and angers me.

There are legitimate reasons for doctors to send to certain imaging centers. Generally, hospitals do poorer quality imaging studies because they have a captive audience (at least in Tulsa). Also, I will usually send to a specific center because either I know that they perform quality imaging studies there or I am the one supervising and/or reading the imaging study.

That brings up another point. If you have an MRI, whether in a hospital or in an outpatient center, you may very well have a non-fellowship trained radiologist reading the MRI. I know this because I constantly have patients bringing in MRI reports from other facilities where the reading radiologist trained before MRI came into existence (in the 1980s) or who is just a general radiologist with no subspecialty training.

While these radiologists are board-certified, that doesn't mean that they are the best person to read your MRI. For example, who would you rather read your mother's mammogram, a fellowship-trained breast imaging specialist or me, a fellowship-trained orthopedic radiologist? When it comes to my family and my patients, I prefer for them to get the best possible treatment, and the most value for their healthcare dollar.

And no, I am not an investor at any of the imaging centers I read at.

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