More on Medicare and Testing

In our previous post, we discussed Dr. Peter Bach’s comments on Medicare funding for unnecessary (in his opinion) testing. In response to Bach’s article on the subject, the NY Times published readers’ letters, most of which were highly critical of Bach’s proposals about Medicare and testing.

The first letter, from Dr. Brant S. Miller, is especially interesting because Miller argues that Bach’s proposals are nothing new:

We already tried capitation with H.M.O.’s in the 1990s, and that turned out to be a disaster. The media reported countless abuses by H.M.O.’s that killed or maimed patients as the insurers paid doctors more for denying care and less for providing care. Fee for service turned into plea for service. So, here we go again.

Since the 1990s, patients have been told that your doctor is greedy and doing unnecessary tests. And by the way, you shouldn’t have to pay much out of pocket, and there shouldn’t be any forms to fill out. Meanwhile, Tim Russert dropped dead when a one-minute CT scan could have shown progression of disease in his left anterior descending coronary artery.

Another interesting letter is from professor of neurology Michael Hutchinson. Hutchinson criticizes Bach for making “sweeping statements” and corrects his portrayal of the facts regarding testing and equipment use:

In fact, an extensive study done by doctors at Massachusetts General Hospital on physician ownership of imaging equipment was published last year. The study failed to define a major increase in imaging by doctors who own their equipment compared with doctors who do not.

Perhaps this has to do with strict government regulation, but imaging costs have actually been declining in the last two years. The total cost of M.R.I. scanning is now a fraction of 1 percent of health care.

Hutchinson also points out that imaging leads to fewer hospital and emergency room visits and also fewer procedures done, which helps reduce health care costs overall.

Those two letters were intriguing, but all of the letters responding to Bach are worth perusing.

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