Well, now we know this wasn’t just one anecdotal news story. Dallas Morning News reporter Ryan McNeill has investigated and found hard numbers to back it up.
The thrust of the report (which is not unlike similar reports we’ve told you about before) is that Texas doctors have been purchasing their own imaging machines (like CT scanners and MRIs), and ordering highly questionable (and profitable!) tests for an ever-increasing number of patients.
"There's a lot of money to be made in owning imaging machines," said president of the Texas Radiological Society, Dr. Richard Strax. "You can buy a relatively inexpensive second or third-hand MRI machine for a few hundred thousand dollars and make millions on it." According to the paper, the Dallas-Fort Worth area alone “exceeded the national rate of CT and MRI scans for Medicare patients in 2005, the latest figures available.”
And at the national level, the medical imaging business is generating $100 billion a year, a number that is expected to double by 2012(!). But Texas is an extra special case, according to Jean Mitchell, an economist and professor at the Georgetown Public Policy Institute, who refers to the state as the “self-referral capital of the world.” Mitchell has studied extensively how costs can balloon when doctors have a financial incentive for ordering extra tests and procedures. “The doctors own everything,” said Mitchell. “It’s self-referral run amok.”
Unsurprisingly, “[a] bill that would have required disclosure of doctors' financial interests in imaging providers failed in the last session of the Texas Legislature after strong opposition from the medical lobby.” And “[f]or three sessions, radiologists and doctors have fought in the Texas Legislature over the issue of self-referral. This year's legislation, backed by radiologists and business lobbyists, would have required licensing and accreditation of imaging machines, along with a year-long state study of the extent of self-referral by physicians. But it failed.”
“It’s all about the money, OK?” said Dr. Cynthia Sherry, past president of the Texas Radiological Society. “Those doctors who are opposed to [this legislation] are the ones participating it.”
Meanwhile, check out these insane numbers:
The Dallas Morning News asked BlueCross and Blue Shield of Texas to provide data for Dallas, Denton, Collin and Tarrant counties. Among the findings: Overall charges to BlueCross for imaging tests increased 100 percent to $1.6 billion during a five-year period ending in 2009.“This is ridiculous,” state Rep. Lois Kolkhorst (R-Brenham), the chairwoman of the House Public Health Committee, told the Morning News. “Why is it everything comes down in price, except for medicine?”
Also, total imaging charges – which are usually more than what providers are actually paid by insurance companies or Medicare – increased 112 percent for scans in hospital outpatient settings, nearly 105 percent in doctors' offices and nearly 62 percent for imaging centers.
An analysis of Texas hospital discharge data by The News found that MRI charges for inpatient care at hospitals statewide doubled, from $409 million to $819 million, between 2002 and 2007.
Here’s a hint: lawsuits didn’t cause this problem and practically eliminating them, like they did in Texas, sure didn’t solve it.