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Sep 1

My reply to the article: High health care costs? The cultural guns turn on commercial screening groups

High health care costs? The cultural guns turn on commercial screening groups

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posted on: august 28, 2012 – 5:10am

Appropriate use of screening tests can improve the health of the population and reduce health care costs through the avoidance of expensive care for advanced disease. Recent publications have emphasized the importance of shared decision-making between physicians and patients who are fully informed about the benefits and harms of screening for common and chronic conditions.

However, according to Steven E. Weinberger, MD, Executive Vice President of the American College of Physicians (ACP), and his co-authors, physician efforts to provide high-quality, cost-conscious care are being “undermined by the increasing availability of direct-to-consumer screening tests.”

Currently, there is a trend of companies selling screening packages directly to consumers. These companies encourage consumers to discuss “abnormal” results with their physicians, potentially leading to more testing, treatment, and/or follow up that may not have been necessary.

The authors recommend that purveyors of such tests should be required to openly state for whom the screening tests are indicated (based on current evidence-based guidelines) and inform customers of potential risks. While some believe that patients may modify risky behaviors if they have a disease identified through screening, evidence proves the opposite.

The authors use carotid ultrasound as an example. Although the prevalence of carotid stenosis is high in patients who smoke and who are interested in quitting, those with an abnormal carotid ultrasound (a screening test commonly offered by commercial screening companies) are no more likely to quit smoking than those who had a negative ultrasound or those who did not receive an ultrasound.

The authors conclude that medical entities and physicians should refrain from sponsoring or supporting health screenings that do not practice ethical standards.

Another opinion piece by radiologist authors being published in the same issue raises analogous issues. The authors call for health care providers to limit imaging tests that are inappropriate, wasteful, or redundant. The authors note that a large proportion of the tests noted by the Choosing Wisely campaign are imaging studies. Choosing Wisely is an initiative by the American Board of Internal Medicine Foundation (ABIMF) that identifies commonly overused tests and treatments.

In January, the ACP published a list of 37 medical tests – of which 18 were imaging tests – that were overused in medical practice. An accompanying editorial pointed out that five percent of the country’s GNP is spent on tests and procedures that don’t improve patient outcomes.

According to the authors, campaigns that draw attention to overuse of imaging, coupled with greater physician knowledge would benefit both patients and the health care system.

DISCLAIMER: I am the owner
Joseph Matthews RVT, RDCS, RPhS (not verified) | September 1, 2012 – 10:43pm
DISCLAIMER: I am the owner and operator of SmartHealth Screening and SonoTech Imaging in California, USA. We provide registered cardiac, vascular and abdominal ultrasound technologists(ARDMS and CCI) to physician offices, vein clinics, acute care facilities, and we even make house calls when patients are home bound. We provide sonographers and machines to referring MD’s for diagnostic exams and offer the same quality service to individuals who are ‘cash-pay’,’out-of-pocket’, and ‘fee for service’. Qualified radiologist, cardiologist and vascular surgeons interpret our exams and results are available in 3-4 days and can be viewed 24/7 through our online patient and physician results portal at Visit to read more about us.

In my opinoin, your article could be confusing for someone reseaerching information regarding ultrasound health screening exams. Please reply through this forum, my website, or my personal email

Please begin by elaborating or explaining your first sentence. You write, “Appropriate use of screening tests can improve the health of the population and reduce health care costs”, I agree. My screening exams for a carotid duplex are $75 through my company while local hospitals in the San Francisco Bay Area send bills to insurance companies for upwards of $2000 for an exam that has essentially the same protocol. Email me personally and I will share my protocols with you. The second half of your first sentence is where you confuse me. You state improved health and reduced cost occur from “…the avoidance of expensive care for advanced disease”. This is not the purpose of a non-invasive ultrasound screening. Contrarily, screenings(revealing previously undiscovered abnormal or advanced disease) would initiate the processes that increase expense of the patients care (bills submitted to the insurance company or invoices directly sent to patients without insurance). This is due to future physical exams by a qualified physician, confirmation (or exclusion) of abnormal findings by diagnostic imaging exams and additional costs due to treatments ranging from conservative management to urgent surgical interventions. We use proven test protocols, only hire registered technologists and have a quality assurance program in place as required by the IAL as we seek vascular and cardiac ultrasound laboratory accreditation.

You state that currently there is a trend of companies offering the services. In my direct area, university hospitals and physician offices themselves offer similar services I offer to out of pocket patients who seek screenings. In fact, I work in these offices currently and perform the same quality service to their patients. Does the ACP (American College of Physicians) think Hospitals, Clinics and Medical Doctors who provide ‘screening exams’ are undermining the current health care system? Probably not. I agree, dubious screening companies are out there, but so are dubious physicians.

It is imperative for consumers who seek screening exams to ask questions about the company and do some research to avoid being ripped off or being taken for an unnecessary and expensive health-care roller coaster ride. Asking a Registered Technologists/ Sonographer to view their credentialing card should be encouraged and done by patients, even in MD offices and hospitals. Many ultrasound laboratories do not use registered tech’s. There are bad techs, bad doctors, bad plumbers, and bad lawyers. A simple Google search reveals phony practicing physicians who never graduated medical school and perform surgeries on unwitting and willing patients looking for medical care. There are ill-qualified professionals in every industry.

In my experience, unnecessary increased health care costs occur withing MD office and hospital systems. Using the carotid example your article does, I cannot tell you how many yearly ultrasounds are ordered and performed for follow-up on patients with minimal disease (<50% stenosis) considered the 'normal range' in official interpretations/ MD dictated results. Often, confirmation of normal range carotid artery stenosis through MRI and CT. This involves office visits and consultations, all which increase health care spending. Due to time constraints I would like to close by saying that SmartHealth Screening, SonoTech Imaging and Joseph D. Matthews RVT, RDCS, RPhS have the mission is to identify people most at risk for cardiovascular disease events so they can seek further medical attention. We do this by providing quality ultrasound imaging exams to self-pay individuals and referring physicians who may or may not have insurance. We compare findings and classify disease using University proven protocols utilized by MD offices, imaging centers and hospitals. Physicians refer cash pay patients to us for screening services and utilize us in their offices for full diagnostic exams. Our expertise and quality in care are probably not commonly found in our local and national competitors. I look forward to your response, Joseph

Smart Health Screening

Ultrasound Laboratories, Inc. dba SmartHealth Screening & SonoTech Imaging. We provide abdominal, cardiac and vascular ultrasound imaging services to physicians offices and patients homes. We accept most insurances including Medicare and Medi-Cal. 1-408-829-6486. Office with Saturday appointments at 305 South Drive, suite 7, Mountain View, CA

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