Waste Not, Want Not

Imaging may be a target, but minor procedures add up to major expenditures, too.

When I was growing up, there were times when I refused to eat something on my dinner plate. Typically, it was something green or mom?s famous macaroni, cheese, and tuna casserole. While my busy yet patient mother just rolled with it, my dad would offer up his regular reaction, ?waste not, want not.? That expression has stuck with me because it hammered home a larger life lesson: What you waste now, you may long for later.

Seems to me everyone?the medical community as well as health care consumers?should keep the ?waste not, want not? message in mind. We all know there is too much waste in the health care system. But are we taking the right steps to remedy the situation? If we don?t address it now, we may one day suffer from a real lack of health care resources.

The diagnostic imaging community is well aware of the problem of imaging overutilization. Providers and manufacturers have made some excellent strides in addressing the issue. We hear a good deal about the availability and use of appropriateness criteria, so physicians can keep up with best practices and order the right exam at the time. (See this month’s “Regulatory Watch“.) Moreover, the Imaging e-Ordering Coalition has successfully convinced Congress to include computer-based physician order entry (CPOE) solutions as a potential method for imaging utilization management in recently passed health care legislation. (See our “Regulatory Watch” article from the August 2010 issue)

My point: The medical imaging community is certainly doing its part to help eliminate waste in the system. In fact, our community is working diligently to ?waste not, want not.? But if you tune in to the mass media reports, you would never know it.

I?m tired of the mass media?s propensity to spotlight medical imaging when discussing the issue of waste in the system. We hear so much about ?too many unnecessary MRIs, CT scans,? and so on. Sure, big-ticket items are easy targets. But what about all the smaller items in the system that add up to a heaping pile of waste?

I recently heard about two wasteful expenditures from two unrelated sources?both senior citizens, each of whom felt their recent ?treatment? was an abuse of the system. In one case, an 89-year-old woman told me about her monthly, let?s call it ?therapeutic pedicure.? A podiatrist visits her assisted living campus and essentially cuts her toenails. According to this elderly lady, ?she spends 5 minutes on me? and then goes on to do the same treatment on 10 or so other seniors. The ?patient? pays a $15 co-pay, but the podiatrist bills CMS $123 for the 5-minute visit?times 10!

Another senior patient told me about his recent accident. He broke his pinky toe. His podiatrist (a different one from the above scenario) carefully taped his two toes together, wrapped them in a bandage and then topped the whole thing off with a special ?boot??you know, the kind made of black foam and specially designed for injuries. When the patient remarked that the entire process was unnecessary (he?d suffered a broken toe in the past and knew that the little toe simply heals itself; in fact, on that original occasion he managed to hike through Austria with the broken digit), the podiatrist insisted nonetheless. Why? Admittedly, this is a guess on my part, but probably because he can bill Medicare for the ?treatment? and the fancy footwear to boot (yes, pun intended!).

It is not my intention to take shots at podiatrists?both scenarios just happen to involve feet?and there are ample examples of other kinds of small wastefulness in the health care system that I could cite. But let?s face it, if senior citizens themselves see these two procedures as wasteful?and the bulk of the money isn?t even coming out of their pockets?maybe someone should rethink reimbursement parameters for these minor procedures.

The irony of it all is that I later turn on 60 Minutes (a program I deeply respect) and I hear about the wasteful medical expenditures on end-of-life care, especially as it concerns the elderly. The commentator talks about too many unnecessary tests (including imaging), too many pharmaceuticals, and so on ? they?re just going to die in the end. Well, when I?m a senior, I?m happy to have my toes in disrepair. Save the money in the system for the imaging that just might save my life?even if I am 80.