President Bush has said that in his second term he will enable Americans to shoulder more of their own health-care financial decisions. So here’s a true-or-false pop quiz:
1. Your recent brain imaging scan was shipped overseas for interpretation.
2. Disease management programs have proved effective, but not at saving money.
Do you know enough about either of these complex economic medical issues to make an informed decision about getting the best bang for your medical buck?
Let’s start with the growing practice of reading U.S. patient scans in foreign countries, a move spurred by a shortage of U.S. radiologists, particularly trauma scans in emergency situations that occur at night.
Several large U.S. radiology groups now outsource these functions to physicians in Australia or India (just two examples), where our night is their day.
Early reports of this practice, sometimes called nighthawking, raised red flags for opponents of outsourcing, who decry the loss of U.S. jobs, not to mention consumer advocates who feared inferior service.
Radiology trade groups countered that they actually welcome the practice because of the labor shortage, but they issued industry guidelines strongly urging that all exams be reinterpreted by U.S.-licensed physicians credentialed in the state where the patient resides.
But not all radiologists agree that this practice is a positive long-term solution.
“I’m in the minority in my profession, but I’m concerned about commoditization of radiology,” said James Borgstede, a practicing radiologist in Colorado Springs and chairman of the American College of Radiology. “In a hospital setting, we provide quality control services, radiation safety education, peer reviews and general community participation. Long term, this is not a good solution if it becomes the norm. There should be local accountability.”
The group has approved of overseas nighthawking, as long as quality standards are met, such as making sure physicians here at home give the scans a close second read the next morning and not just a rubber stamp.
So, are the standards actually being met? Borgstede couldn’t say with certainty that the so-called “ghost” reporting, or rubber stamps, are not happening.
As for the old mantra that closely managing chronic conditions would be cost-effective as well as just plain effective, well, that idea may be waning, too.
Heart-failure patients involved in an extensive disease management program showed positive medical results but no reduction in costs for things like medicine and hospital stays, according to researchers at the University of Texas Health Sciences Center in San Antonio. The team presented its findings at an American Heart Association convention this month.
And a new survey of roughly 39,000 U.S. workers by Hewitt Associates shows that fewer than half make an estimate of their family’s future health-care costs, put money aside to pay for health expenses or track them after the fact. Lower-income workers were even less likely to do so.
“A significant proportion of employees seem willing to take on more responsibility for their health-care decisions,” the Hewitt report concluded. “However, they need tools, information and resources to help them adopt these desired behaviors. With more than 50 percent of employees saying they don’t know if such tools are provided, it will be a challenge to see significant behavioral shifts.”
Another physician I spoke with was more blunt.
“Ninety-nine percent of patients have no clue how to ascertain clinical quality. This vision of a driven health-care consumer wanting to be more involved … I’m skeptical,” said Arl Van Moore Jr., chairman of an American College of Radiology task force that set standards for nighthawking. “For true consumer markets to work, you have to have information, and we just don’t have that yet.”
We saw the crippling result when Enron employees loaded up their retirement accounts with company stock.
What will be the new health system’s Enron? It’s time to bone up.
———-
E-mail Janet Kidd Stewart at yourmoney@tribune.com.
