The answer is no. According to a study in the Archives of Internal Medicine, 7 percent of abnormal test results from primary care offices were never reported to the patient. And in a large, unnamed, academic medical center, that number ballooned to 23 percent.

That’s almost a quarter of abnormal test results from that center that patients were never notified about. Talk about a malpractice time bomb waiting to go off.

Of course, practices with electronic medical records have the lowest rate of missed notifications, but interestingly, practices that combined paper charts and EMRs fared the worst of all.

Doctors receive hundreds of lab and x-ray reports, along with consultant letters and hospital admission notes and discharge summaries, each day, and it’s easy for a single result to slip through the cracks.

So, as a patient, if you haven’t heard anything one week after a given test, I would call your doctor’s office to follow-up on the results.

Posted at KevinMD.com. Stay updated and subscribe or follow me @KevinMD on Twitter.

by James H. Thrall, M.D.

Health care reform cannot be approached with a “one size fits all” cost-cutting mentality. Reducing costs in the long term often requires an investment in the short term — particularly, in regard to medical imaging.

Medical imaging saves lives. Imaging also saves dollars through earlier disease diagnosis, less invasive medical procedures, shorter hospital stays, and optimized patient treatment. Researchers at Harvard Medical School demonstrated that every $1 spent on inpatient imaging translates to approximately $3 in total savings. But with an urgency to cut costs now, the long-term picture has fallen out of focus.

The Administration recently recommended a radical change to the Medicare reimbursement formula for imaging services. Specifically, it called for increasing the formula’s utilization assumption to 95 percent —even more extreme than Medicare Payment Advisory Commission’s suggested increase to 90 percent.

The utilization assumption is the percentage of a facility’s operating time that the equipment is assumed to be in use and is a key component of the Medicare formula used to calculate reimbursement. If the assumption is dramatically higher than the actual time a facility’s machines are in use, the center will be significantly underpaid for their services.

According to data recently collected by the Radiology Business Management Association, imaging centers in rural areas operate equipment approximately 48 percent of the time their offices are open. Imaging centers in non-rural areas operate equipment approximately 56 percent of office hours.

A 90-95 percent utilization rate for CT and MRI scans would result in an additional 30+ percent reimbursement cut for these modalities, on top of an average 23 percent hit resulting from imaging provisions in the Deficit Reduction Act of 2005 and even more reductions called for in the CMS’ proposed Physician Fee Schedule Rule. With cuts this deep, there will be minimal if any access to advanced imaging in rural America. Even suburban and urban providers may find it hard to continue to offer the same level of service — all leading to longer travel for care and longer wait times.

MedPAC has stated and the Centers for Medicare and Medicaid services agreed that the survey used to justify the Administration’s proposal, based on data from six large urban areas, was not sufficient to drive national reimbursement policy. The recent RBMA data shows why.

Everyone wants to improve health care, but clearly the evidence does not support legislation that would so drastically impact patient access to care.

James H. Thrall is chair of the American College of Radiology (ACR) Board of Chancellors.

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Regular readers of this blog know about the risks of cancer screening, especially prostate cancer, which can lead to unnecessary biopsies necessitating invasive procedures that can lead to life-altering side effects. All for a slow-growing cancer that may not have led to death.

The problem with prostate cancer is that the current detection methods, like the prostate specific antigen, are not accurate enough to determine the severity and prognosis of tumors.

But that isn’t stopping John Kerry and Don Imus (what an odd couple) from writing a recent op-ed in the Boston Globe. In their piece, they draw attention to the poor screening rates in African-American men, recommending that “African-American men should start being screened for prostate cancer at age 45, five years earlier than men of other races. All men, regardless of race, should be screened earlier if there is a history of prostate cancer in the family.”

Now, that flies in the face of the USPSTF prostate cancer screening guidelines, and perpetuates the false notion that earlier screening equates to better medicine. But that isn’t always the case.

If the authors had, for instance, advocated that more doctors discuss the risks and benefits of prostate cancer screening with African-American men, that would have been acceptable. But instead, they chose to ignore the nuances surrounding screening, in order to generate a lazy Father’s Day editorial instead.

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But, in this well-reasoned piece by conservative economist Tyler Cowen, expanding coverage won’t necessarily control costs, which is a more imperative issue. The bandied about means of cost control, such as electronic medical records, cutting provider payments, and preventive care, all will have little nor no impact in controlling costs.

Take physician reimbursements, for instance, a favorite target of health reforms. According Princeton economist Uwe Reinhardt, a favorite son among policy wonks, cutting physician pay by 20% would only reduce spending by 2%.

Furthermore, under the current payment system, simply cutting provider reimbursements will only give more of an incentive to do more procedures to make up for lost revenue.

The hard truth is that care will be rationed, and that’s something the Obama administration is unwilling to admit. Indeed, as Mr. Cohen writes, “if we aren’t willing to take even limited steps to conserve resources, we shouldn’t be spending any more money elsewhere.”

Cost control first before universal coverage, and therein lies the central contention of the debate.

And the worst case scenario, as progressive blogger Ezra Klein correctly surmises is, “that the final bill will include a pricey expansion of coverage paired with a speculative and uncertain set of cost controls.”

Posted at KevinMD.com. Stay updated and subscribe or follow me @KevinMD on Twitter.

So, naturally, ads like these from the Zurich Chamber Orchestra, which capture the intersection between classical music and medicine, catch my eye.

Beautiful.

(via Street Anatomy)

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In a recent op-ed in the WSJ, maternal-fetal medicine fellow Adam Wolfberg talks about the potential complications of chorionic villus sampling (CVS) (via Suture for a Living). Used to assess the risk of Down Syndrome in the fetus, it involves inserting a 3 1/2 inch needle into the mother’s uterus to obtain cells from the placenta. The rate of miscarriage is around 1 percent.

But studies have shown that doctors who perform more CVS procedures have a lower complication rate. Thus, a dilemma presents itself, where physician’s “present-day patients benefit at the expense of previous patients.”

Unlike surgeries, where doctors can learn within a team construct, CVS involves an individual doctor with a single needle. And despite the various ways institutions have tried to train doctors doing the procedure, such as using computer models, pigs, women undergoing elective abortions, none compare to doing it in a real-life situation.

Consequently, those that are qualified to perform CVS are swamped, and there’s a long wait for mothers who require the test.

Posted at KevinMD.com. Stay updated and subscribe or follow me @KevinMD on Twitter.

In the interview, the patient admits calling 911 and feigning chest pain. Why?

What the caller, and only the caller, knows is that his chest is not throbbing in pain. Actually, his chest is fine. What he has done is just reserve his personal medical limousine for transport to the head of the line at the area emergency room — an emergency room that may unknowingly feed his current prescription drug addiction.

The caller also knows that Lawrence County taxpayers are going to pick up the dime for the entire trip. Not a single cent is coming out of his pocket. He does not have insurance and has no intention of paying for the trip.

Indeed, statistics show for that particular area’s EMS services, 50 percent of their calls are not for true emergencies.

Although it’s true that patients often won’t know what is a true emergency or not, a growing trend is that “another chunk of the non-emergency calls [EMS] responds to comes from an underground society of prescription drug addicts who know how to beat the system and . . . taxpayers out of hundreds of thousands of dollars annually.”

Why do they do it? Well, according to one addict, “Because more often than not, it works.”

Read the whole piece. It’s quite sobering.

(via WhiteCoat)

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But, according to a study cited by Pauline Chen in a recent New York Times column, it’s part of the doctor-in-training culture. In fact, residents “from seven different specialties and found that they set themselves up for burnout by accepting, even embracing, what they believed would be a temporary imbalance between the personal and professional aspects of their lives.”

What happens if that imbalance isn’t so temporary? For instance, primary care doctors are reporting an increasing frequency of physician burnout, facilitated by the increasing bureaucratic hassles and the extra number of thankless hours they have to spend taking care of an unending number of patients.

Without a work-life balance, most doctors cannot be sustained by professional growth alone and “are at risk of burnout, clinical depression or, more commonly, subtle forms of stress,” and indeed, “the danger is that physicians may end up leaving the work force or will become less effective caregivers.”

And that’s exactly what you’re seeing in primary care today.

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As MedPage Today reports, the FDA has warned patients to stop using Zicam, as the product can lead to anosmia, or loss of the sense of smell.

This isn’t a new claim, since, “In 2006, the company paid $12 million to settle 340 lawsuits brought by consumers who claimed the zinc nasal gel adversely affected their sense of smell.”

Amy Tuteur is more blunt about the Zicam experience, writing in her blog that, “You’ve got to hand it to the folks at Matrixx Initiatives [the makers of Zicam]. They managed to convince millions of Americans to paint the inside of their noses and throats with a toxic heavy metal that is ineffective in its stated benefit and destroys the nerves responsible for the sense of smell.”

It’s all the more reason why the FDA should step in a regulate these homeopathic products that can be potentially dangerous.

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Not only the time between an appointment and the office visit, but once there, the time it takes to actually see someone.

After internist Jan Gurley breaks down the numbers, it’s easy to see why. Primary care doctors, on average, have patient panels averaging 2,500 patients or so. Assuming full-time working doctor who only takes the 10 federal holidays off per year, “[patients]  ‘own’ only (50 weeks X 40 hours, minus 10 X 8 hours, minus 50 weeks X 8 hours; divided by 2500) 36 minutes a year of [their] doctor’s time.”

That’s assuming a situation of no delays, no complications, and an efficient practice - traits that are not common in many offices.

And after citing a JAMA study concluding it takes primary care physicians about 18 hours a day to provide the spectrum of recommended preventive care tests and counseling to a typical patient, it’s no wonder that providing good health care is, as Dr. Gurley states, “physically impossible.”

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