Ratioining propaganda again

Sorry to post serious stuff on the weekend, but THIS made me mad (via drudge).

WAPOST discussing why greedy docs won't take more medicaid patients includes this quote.

"Then you have doctors who order an MRI for an unremarkable headache or at the first sign of back pain," said Robert Berenson, a Commissioner of the Medicare Payment Advisory Commission, an independent congressional agency. "It's pretty well documented that it doesn't help patients to have those scans done in these cases. But if you have the machine in your office ... why not?"

Huh? An MRI in "every office"? yes in very large private clinics, but as a doc who was sued for not ordering a sophisticated test only available 500 miles away, excuse my sarcasm.

An MRI machine costs one million dollars a piece.

Here is the NYTimes propaganda piece on all these excess tests, and they use Syracuse NY to prove their point.

In the Syracuse area, the number of magnetic resonance imaging machines has grown by a third over the last three years. In the 12 months ended last June alone, use of M.R.I. scans in the area increased 23 percent, according to National Imaging Associates, a company that works with insurers to manage costs.

Syracuse area has over 700thousand people. So that is not an MRI in every office. But I do notice something: MRI is said to cost $700, but when I practiced, it was $2000 so it seems that competition is making the price go down. A lot of these MRI's are in specialists offices, and it is a lot more convenient for Grannie to get one on site than schedule three weeks ahead in an inner city hospital to have it done, which is how we had to do it in Oklahoma in the year 2000.

I do agree that MRI or CT scan done as self refered screening is not warranted, but on the other hand, what this is actually about is that in the future, MRI will replace other tests.

For example, if you think the discussion about mammograms is hot, wait till you find out that a breast mammogram is a lot better at detecting cancer.

Similarly, in the past, to detect heart disease, you did an angiogram, which is "invasive" and so you didn't do it for every one.

Now, you can just do a spiral MRI and voila, your coronary arteries are checked.

and now they even have MRI's that don't expect you to sit inside a tube that makes noise. Open MRI's are good for the ten percent of people who are claustrophobic, or obese.

finally, the WAPO articl has this part:

Still, even if primary-care doctors had to rely exclusively on Medicare's lower payment rates their incomes would only drop about 9 percent, according to a recent study co-authored by Berenson, who is also a fellow at the non-partisan Urban Institute.

uh, no. You see, that is assuming that Medicare pays you. Too often, it means you end up spending more on clerks to resubmit or even to call and follow up why the payment didn't come. Having a purely medicare office means a lot more overhead.

And it also means that, since Medicare pays only a percentage of your expenses, that people with insurance or without insurance have to pay a larger fee to make up the difference.