From: Steve Harris <sbharris@ix.netcom.com> Newsgroups: misc.consumers,sci.med,alt.politics.economics Subject: Re: CAT scans, MRIs, Ultrasounds, and X-rays Now Read In India Date: 24 Apr 2005 20:50:39 -0700 Message-ID: <1114401039.791569.12880@o13g2000cwo.googlegroups.com> >>April 24, 2005 Hospital Services Performed Overseas Training, Licensing Questions Raised By Rob Stein Washington Post Staff Writer When patients needed urgent CAT scans, MRIs and ultrasounds late at night at St. Mary's Hospital in Waterbury, Conn., emergency room workers used to rouse a bleary-eyed staff radiologist from his bed to read the images. Not anymore. The work now goes to Arjun Kalyanpur -- 8,000 miles away in Bangalore, India. When it is the middle of the night in Connecticut, Kalyanpur is in the middle of his day, handling calls from St. Mary's and dozens of other American hospitals that transmit pictures to him electronically so he can quickly assess them and advise their doctors. << ===================================== Future Emergency Department Scene Doctor: "Okay, who's up on the board? Bed 3?" Nurse: "Mrs. Jones, 85 year-old female, brought in from Golden Sunsets Manor complaining of low back pain with radiation to right leg." Doctor: Could be a radiculopathy. I'll fill out the form for the MRI. We can bill Medicare for that. At least the hospital will be happy, and the hospital pays my salary, you know. Call me when the report comes in from Bombay or Bangalore or wherever. Boy, the local group of radiologists were sure pissed when the hospital didn't renew their contract! But they all made 3 times the salary I do, so I'm not crying much for them. Poor guys. Ha. They might have to go interventional, and actually have to *touch* patients somewhere. [Later] Nurse: Here's the MRI report on Bed 3, Doctor. Doctor: Hmmm. Look how they spell nerve "fibre". And "Radiological Speciality." Wonderful. Well, anyway, nothing here except a couple of partly collapsed vertebrae, and they're cervical so that's not the source of our pain. Okay, I'll write her for some physical therapy, 3 times a week. You know anybody who can't use a little physical therapy? Certainly not any 85 year-olds who can't. Nurse: You ARE going to see her?? Doctor: Sure. I'm going to poke my head in and say "hi." Maybe prod her back a little and see if she moves her feet. Look, Medicare pays about $36 for one of these, and that's about enough time to say "hi." Unless I dictate a complete exam, which I'm not about to do for an elderly lady with low back pain, since whether she's demented or not, that will take so long Medicare will never pay enough to wins at that. So we're not going there. Nurse: What does Medicare get billed for the MRI? Doctor: $1300 or so. I should have added contrast. And they pay way more for an emergency room visit than any doctor would get for an office exam, I'll tell you. But look what they saved in reading fees. Boy, did I mention how pissed off our rad guys were when they all got fired? Nurse: Did she need the MRI? Doctor: How should I know! They don't pay me enough to find out. And no neurologist is going to come in at this hour, because they SURE wouldn't pay one of them enough. Medicare clearly wants to pay for lots of MRI machines, and lots of MRI machines is what they get. I'm OUT of that game. Who's our next patient? Nurse: Mr. Smith, 69 year-old man with upper abdominal pain. Doctor. Ah. Okay, CBC, chem panel, 12-lead, and enzymes. If this guy hasn't had a heart cath, it's even money he's getting one before he leaves. Can't really rule out coronary syndrome without it, you know. Big bills there. I should have gone into cardio, you know. I wonder how long it will be before Bombay reads those angiograms, too? But at least they can't DO 'em.... SBH From: Steve Harris <sbharris@ix.netcom.com> Newsgroups: misc.consumers,sci.med,alt.politics.economics Subject: Re: CAT scans, MRIs, Ultrasounds, and X-rays Now Read In India Date: 25 Apr 2005 12:21:08 -0700 Message-ID: <1114456868.650369.150390@l41g2000cwc.googlegroups.com> >>If the individuals in this littel skit aren't going to touch or talk with the patient then why would their "services" be required to be local? << That's a very good question. And in fact the modern "health-care-system" is systematically finding ways to cut the salaries of anybody who takes medical histories for a living. Which is why you find all that expensive surgery and imaging/scanning and pill-prescribing (which takes little time for the doctor) instead. Physical exam is still being paid for, grudgingly, but at a lower rate. So you're finding non-surgeon doctors doing more of it than they ever used to. Which results in puzzled patients going in for arm pain and getting stripped for the full physical. "Your doctor is trying to save your life with that digital rectal exam! You might have prostate cancer with metastasic disease to your arm bone!" And if you believe that, I've got land in Florida you should look at. Screening prostates has more to do with E/M and HCPCS codes than it does the standard of medical practice. If your rectum is irritated, you can chalk it up to the political system. Which (don't you know) usually does that to you. Have you noticed? SBH |