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Florida Health News: It’s a scan-dal

It’s a scan-dal: Floridians undergo lots of testing

By KUMARI KELLY

Florida Health News

ORLANDO — Floridians undergo medical scans, including CAT scans and magnetic resonance imaging, far more often than most Americans, exposing them to radiation and driving costs up, a researcher told journalists Tuesday.

“This is an area where Florida stood out,” said Glen Mays, chairman of the Department of Health Policy and Management at the University of Arkansas at Little Rock, who has done extensive research comparing Florida with other states. He spoke in Orlando at a conference presented by the Foundation for American Communications, a non-profit group.

“This is where we are seeing rapid growth in the U.S. and rapid growth particularly in Florida.” Per capita spending on imaging and related diagnostic services has more than doubled in Florida in recent years, Mays said.

The spending is fueled by more and more physicians buying imaging equipment for their offices instead of referring patients to hospitals or other specialty centers. The services, he said, are moneymakers. Imaging is one of the hottest health specialties in the country. Employment of diagnostic medical sonographers, for instance, is projected to increase 19 percent by 2016, according to the Department of Labor. Medical groups and clinics invest a lot of money in imaging equipment, Mays said, which means it has to get a lot of use. So instead of suggesting an x-ray, he said, a physician who has a scanner next door will send the patient for a scan instead. It’s convenient.

But scanning exposes a patient to radiation and too much of it can have “significant health risks,” Mays said. Patients sometimes seek out CAT scans and MRIs because they think they’re more modern and accurate than x-rays or ultrasound and will give them a better quality of care, Mays said. It’s true that imaging can detect more subtle abnormalities and are vital in diagnosing certain conditions.

Some say the rule against physicians referring patients to services in which they hold a financial interest should apply to imaging. But cardiology groups and rural physicians have argued strongly against it. Congress held hearings on the overall growth in spending on imaging in 2005. Data released at that time showed imaging services performed between 1993 and 2002 by non-radiologists climbed 49 percent. Medicare payments grew by 72 percent for radiologists and by 119 percent for non-radiologists, according to a report from those hearings.

Florida’s role as big spender in health services goes beyond scanning, speakers at the forum said. A map of the country that showed the per-person spending by Medicare graphically displayed the state’s tendency to excess in health services among the Medicare population. And the message hasn’t yet sunk in that areas that have the most intensive services get worse patient outcomes than more-moderate medical cultures — an important conclusion of research at Dartmouth published two years ago, Mays said.

Those who don’t have coverage under a government program are far more likely to be uninsured if they live in Florida than in the nation as a whole, behind only Texas and New Mexico, according to data presented at the conference. Thirty-two percent of Floridians surveyed in July by the Kaiser Family Foundation and Harvard School of Public Health said paying for heath care and insurance was a top financial issue and 28 percent said someone in their family had problems paying medical bills in the past year. Seventeen percent said they used up all or most of their savings to pay medical bills.

Paul Duncan, chairman of the Department of Health Services Research at the University of Florida in Gainesville, told the group that about 3.5 million Floridians were without health insurance in 2007, including 700,000 children.

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Kumari Kelly can be reached at kumarikelly2008@gmail.com.

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