Federal law generally prohibits physicians from referring their own patients to a diagnostic facility in which they have an ownership issue — a practice called “self-referral” — unless the facility is located in their own practice. This exemption exists to allow patients with access to a laboratory test, X-ray, or other imaging test at the same time and place as when patients are seeing their physician for an office visit. Less inconvenience and speeder diagnosis and treatment — what could be wrong with that?
Much, say the critics, if it leads to overutilization and higher costs and doesn’t really represent a convenience to patients. This is the gist of two studies by staff employed by the American College of Radiology, published in the December issue of Health Affairs.
One study analyzes Medicare claims data and concludes that patients aren’t really getting “one-stop-shopping” convenience when their physician refers them to an imaging facility that qualifies for the “in-office” exemption.
“Specifically, same-day imaging was the exception, other than for the most straightforward types of X-rays. Overall, less than one-fourth of imaging other than these types of X-rays was accompanied by a same-day office visit. The fraction for high-tech imaging was even lower — approximately 15 percent.” Read more »
An international team of researchers has developed a rather reliable test that predicts the future improvement of reading abilities in kids with dyslexia. The method uses functional MRI (fMRI) and diffusion tensor magnetic resonance imaging (DTI) to scan the brain, and data crunching software to interpret the data. The researchers hope that the finding will help parents and therapists uniquely identify which learning tools are best for each child.
From the announcement by Vanderbilt University :
The 45 children who took part in the study ranged in age from 11 to 14 years old. Each child first took a battery of tests to determine their reading abilities. Based on these tests, the researchers classified 25 children as having dyslexia, which means that they exhibited significant difficulty learning to read despite having typical intelligence, vision and hearing and access to typical reading instruction.
During the fMRI scan, the youths were shown pairs of printed words and asked to identify pairs that rhymed, even though they might be spelled differently. The researchers investigated activity patterns in a brain area on the right side of the head, near the temple, known as the right inferior frontal gyrus, noting that some of the children with dyslexia activated this area much more than others. DTI scans of these same children revealed stronger connections in the right superior longitudinal fasciculus, a network of brain fibers linking the front and rear of brain.Read more »
*This blog post was originally published at Medgadget*
At the Charité Hospital in Berlin, researchers have built a specialty MRI machine with enough space to fit a woman undergoing labor. The Local, a German newspaper in the English language, is reporting that the first images of a baby moving through the birth canal have been captured, and that the mother and child are doing just fine. The clinicians involved in the project hope to be able to study why some women end up requiring a Caesarian section, while others do not.
This video illustrates real-time MRI of vocal performance. It includes examples from a soprano and an emcee/beatboxer. This video was featured at the Sounds and Visions Session of the International Society for Magnetic Resonance in Medicine (ISMRM) Scientific Sessions, May 2006, Seattle.
Kudos to Christopher Snowbeck and the St. Paul Pioneer Press for digging into new Medicare data to report that the state the newspaper serves is out of whack with the rest of the country in how many expensive MRI scans are done on Minnesotans’ bad backs.
Snowbeck artfully captures the predictable rationalization and defensive responses coming from locals who don’t like what the data suggest. Because what they suggest is overuse leading to overtreatment. So here’s one attempt a provider makes to deflect the data:
“The Medicare billing/claims data, which this report is generated from, would not capture conversations between a patient and provider that may have addressed alternative therapies for lower back pain,” said Robert Prevost, a spokesman for North Memorial Health Care. “It’s important to recognize the limitations of this data.”
No, data don’t capture conversations. But wouldn’t it be fascinating to be a fly on the wall during those many patient-physician encounters that led to an MRI to see what level of truly informed shared decision-making (if any) took place? Read more »
It’s no secret that doctors are disappointed with the way that the U.S. healthcare system is evolving. Most feel helpless about improving their work conditions or solving technical problems in patient care. Fortunately one young medical student was undeterred by the mountain of disappointment carried by his senior clinician mentors…
I am proud to be a part of the American Resident Project an initiative that promotes the writing of medical students residents and new physicians as they explore ideas for transforming American health care delivery. I recently had the opportunity to interview three of the writing fellows about how to…
I m often asked to do book reviews on my blog and I rarely agree to them. This is because it takes me a long time to read a book and then if I don t enjoy it I figure the author would rather me remain silent than publish my…
When I was in medical school I read Samuel Shem s House Of God as a right of passage. At the time I found it to be a cynical yet eerily accurate portrayal of the underbelly of academic medicine. I gained comfort from its gallows humor and it made me…
I am hesitant to review diet books because they are so often a tangled mess of fact and fiction. Teasing out their truth from falsehood is about as exhausting as delousing a long-haired elementary school student. However after being approached by the authors’ PR agency with the promise of a…