4 ms·

I can’t speak to US billing practices on the facility fee side, in general though Canadian fee codes for the professional fee/reporting component are higher tha

I can’t speak to US billing practices on the facility fee side, in general though Canadian fee codes for the professional fee/reporting component are higher than the US. The tendency to proceed to CT early is largely because: 1. A lot of ED centres are financially rewarded if they keep time to disposition within target (either directly in Canada or for throughput in US). If the CT identifies a cause for admission and a service is consulted that patient is officially “discharged” from ED even if they are physically still there waiting for the specialty consultation / admission. 2. Generally unjustified malpractice fears in both US/CAN, the theoretical risk of cancer down the line is impossible to tie to an individual imaging study, but there is a lot of fear for missed diagnosis. Despite risk scoring systems for things like pulmonary embolism I see a lot of patients with pneumonia on X-ray (I.e. an explainable cause for chest pain) getting these studies “just to be safe”. Overalll positivity rates on these studies is 1-2%, despite how much this imaging has become utilized (something like 10-20x increase over the last 10 years) we have not seen corresponding reductions in mortality suggesting overimaging, but research is ongoing. As a radiologist I try my best to reject unnecessary scans, but it’s difficult to do so when a clinician is telling you “I’m scared about deadly condition x”. When they’re younger I can apply the radiation risk consideration and suggest shared decision making, in some outlandish requests (I was asked to CT an 18 year old male with a fever, negative blood work and zero risk factors for PE, so likely viral illness or asthma) I outright refuse but those cases are few unfortunately as most presentations are elderly patients.

maxerickson 4y ago
The radiologist interpretation fee is almost always like $20 straight up, that part of it seems to be working just fine.
- haldujai 4y ago
  Do you know what the facility/hospital fee component is out of curiosity?
  - maxerickson 4y ago
    For a head CT scan I had a few years ago, where the ER doctor likely ordered it to rule out an abscess in my jaw (I didn't interview her to understand her thinking), I paid ~$2000 for the scan, like $700 for the ER visit, like $500 to the doctor and like $20 to the radiologist. The doctors billed separately. It was just a sinus infection that was irritating a cavity, which was making my whole jaw ache to where I couldn't sleep (overnight Saturday), and I went in out of some combination of panic and concern that it was escalating. It rankles me to no end that they up charged the visit because of the consult, where what really happened is the doctor ordered a test that allowed someone else to do a definitive diagnosis and more or less completely removed their liability (both by removing uncertainty and by shifting it). I also can't begin to reconcile the cost of the scan itself (but don't really have any information about their actual costs). I dunno, maybe it did actually cost them a bunch of money to wheel me over to the CT room and back.
    - haldujai 4y ago
      Yeah that’s insanely upcharged. Being generous a high end ER CT scanner is in the $200,000 to $300,000 range. Contrast is a few bucks. Technologist + porter are generously paid $100 combined + whatever you want to give for overhead, noting a lot of these employees are officially “part time” to save on benefits. Given that an average ER scanner does something like 80 studies a day, sounds like they’re depreciating over a week…
      - maxerickson 4y ago
        That matches the 'ballpark' costs I had sort of assumed. It's a small town hospital, so I wouldn't be surprised if their volume is quite a bit lower than that. Which still doesn't get to the cost being reasonable. 35,000 people in the county, with some of those people being closer or equal distance to other facilities.

maxerickson 4y ago

The radiologist interpretation fee is almost always like $20 straight up, that part of it seems to be working just fine.

haldujai 4y ago
Do you know what the facility/hospital fee component is out of curiosity?
- maxerickson 4y ago
  For a head CT scan I had a few years ago, where the ER doctor likely ordered it to rule out an abscess in my jaw (I didn't interview her to understand her thinking), I paid ~$2000 for the scan, like $700 for the ER visit, like $500 to the doctor and like $20 to the radiologist. The doctors billed separately. It was just a sinus infection that was irritating a cavity, which was making my whole jaw ache to where I couldn't sleep (overnight Saturday), and I went in out of some combination of panic and concern that it was escalating. It rankles me to no end that they up charged the visit because of the consult, where what really happened is the doctor ordered a test that allowed someone else to do a definitive diagnosis and more or less completely removed their liability (both by removing uncertainty and by shifting it). I also can't begin to reconcile the cost of the scan itself (but don't really have any information about their actual costs). I dunno, maybe it did actually cost them a bunch of money to wheel me over to the CT room and back.
  - haldujai 4y ago
    Yeah that’s insanely upcharged. Being generous a high end ER CT scanner is in the $200,000 to $300,000 range. Contrast is a few bucks. Technologist + porter are generously paid $100 combined + whatever you want to give for overhead, noting a lot of these employees are officially “part time” to save on benefits. Given that an average ER scanner does something like 80 studies a day, sounds like they’re depreciating over a week…
    - maxerickson 4y ago
      That matches the 'ballpark' costs I had sort of assumed. It's a small town hospital, so I wouldn't be surprised if their volume is quite a bit lower than that. Which still doesn't get to the cost being reasonable. 35,000 people in the county, with some of those people being closer or equal distance to other facilities.