Picturing what’s next in cutting health costs

By Jack Sullivan

Paul Levy, president and CEO of Beth Israel Deaconess Medical Center, has an insider’s take on an emerging trend in medical imaging that is having an effect on his hospital’s bottom lines and could be spreading to other hospitals as well.

In a post earlier this week on his blog “Running a Hospital,” Levy reveals that the number of CT scans performed at BIDMC in the last year is declining even though the number of patients has increased. Levy and his chief of radiology, Dr. Jonathan Kruskal, had some insightful comments in our summer issue cover story “Overexposed,” which detailed the spike in the use and cost of advanced medical imaging.

Levy shared some information from Kruskal about what is happening at the hospital and, given the state and attention being paid to health care these days, it’s hard to believe BIDMC is an outlier.

“We are about 10 percent down in CT cases from last year, due to a combination of patient and physician fears about radiation exposure, more prudent ordering of studies by physicians, leakage out of the medical center, and the introduction of physician incentive programs (to minimize the amount of imaging) by some insurers,” Kruskal wrote to Levy. “Also, and very surprising, we have not seen an upswing in ultrasound or MRI to match the CT volume drop.”

Levy and Kruskal point out that the hospital relies most on CT scans for its imaging revenue stream so the reduction without a concomitant increase from other types of imaging procedures is going to have a major impact on the overall budget, including reduced salaries and size of radiology staff.

But don’t think the shrinking number of imaging procedures indicates a decline industrywide. Kruskal says the radiology department has also seen an increase in the number of patients that come in with their tests on CD-ROMs that were performed at cheaper, free-standing facilities. The doctors are asked to reinterpret the scans but do not bill the patient or the insurance company for that effort, even though it costs the hospital to store the information and the radiology department has to dedicate manhours to the procedure.

Meet the Author

Jack Sullivan

Senior Investigative Reporter, CommonWealth

About Jack Sullivan

Jack Sullivan is now retired. A veteran of the Boston newspaper scene for nearly three decades. Prior to joining CommonWealth, he was editorial page editor of The Patriot Ledger in Quincy, a part of the GateHouse Media chain. Prior to that he was news editor at another GateHouse paper, The Enterprise of Brockton, and also was city edition editor at the Ledger. Jack was an investigative and enterprise reporter and executive city editor at the Boston Herald and a reporter at The Boston Globe.

He has reported stories such as the federal investigation into the Teamsters, the workings of the Yawkey Trust and sale of the Red Sox, organized crime, the church sex abuse scandal and the September 11 terrorist attacks. He has covered the State House, state and local politics, K-16 education, courts, crime, and general assignment.

Jack received the New England Press Association award for investigative reporting for a series on unused properties owned by the Catholic Archdiocese of Boston, and shared the association's award for business for his reporting on the sale of the Boston Red Sox. As the Ledger editorial page editor, he won second place in 2007 for editorial writing from the Inland Press Association, the nation's oldest national journalism association of nearly 900 newspapers as members.

At CommonWealth, Jack and editor Bruce Mohl won first place for In-Depth Reporting from the Association of Capitol Reporters and Editors for a look at special education funding in Massachusetts. The same organization also awarded first place to a unique collaboration between WFXT-TV (FOX25) and CommonWealth for a series of stories on the Boston Redevelopment Authority and city employees getting affordable housing units, written by Jack and Bruce.

About Jack Sullivan

Jack Sullivan is now retired. A veteran of the Boston newspaper scene for nearly three decades. Prior to joining CommonWealth, he was editorial page editor of The Patriot Ledger in Quincy, a part of the GateHouse Media chain. Prior to that he was news editor at another GateHouse paper, The Enterprise of Brockton, and also was city edition editor at the Ledger. Jack was an investigative and enterprise reporter and executive city editor at the Boston Herald and a reporter at The Boston Globe.

He has reported stories such as the federal investigation into the Teamsters, the workings of the Yawkey Trust and sale of the Red Sox, organized crime, the church sex abuse scandal and the September 11 terrorist attacks. He has covered the State House, state and local politics, K-16 education, courts, crime, and general assignment.

Jack received the New England Press Association award for investigative reporting for a series on unused properties owned by the Catholic Archdiocese of Boston, and shared the association's award for business for his reporting on the sale of the Boston Red Sox. As the Ledger editorial page editor, he won second place in 2007 for editorial writing from the Inland Press Association, the nation's oldest national journalism association of nearly 900 newspapers as members.

At CommonWealth, Jack and editor Bruce Mohl won first place for In-Depth Reporting from the Association of Capitol Reporters and Editors for a look at special education funding in Massachusetts. The same organization also awarded first place to a unique collaboration between WFXT-TV (FOX25) and CommonWealth for a series of stories on the Boston Redevelopment Authority and city employees getting affordable housing units, written by Jack and Bruce.

Although health plans will not pay for two interpretations of the same scan, it’s unlikely that any hospital will continue to perform services like this for long without getting some kind of reimbursement.

There are some very interesting comments on the post as well, clearly from people in the field well-versed on the issues. It’s worth the time to read them all.