I couldn't agree more with your editorial on the Centers for Medicare and Medicaid Services and CT colonography
To the Editor,
I couldn't agree more with your editorial on the Centers for Medicare and Medicaid Services and CT colonography ("U.S. needs more colon cancer screening options, not fewer," page 5, May). I submitted my thoughts to CMS pre- and post-Feb. 11, and I'm just flabbergasted that the people making these decisions are still dragging their feet on virtual colonoscopy. We've been doing these procedures for the last seven years, our radiologist has read thousands of these studies, and we work closely with the gastroenterology community to take care of their compromised patients, failed and incomplete procedures, and our patients who need therapeutic procedures.
My only conclusion is that the CMS group must be in the nonpracticing world. Do they not know or calculate the millions of dollars CMS spends on removing benign polyps? Most polyps that are removed in that setting because "we're already in here" and "it increases our reimbursement" are benign; we are only adding risk for the patient. Nobody ever seems to mention that with CT colonography we identify small polyps below even the 6-mm threshold and-without any additional cost or risk to the patient-simply recommend that we repeat the exam in five years to see if there are any changes.
In our experience, about 97% of "screening" exams turn up no polyps. Of course, we do identify other treatable problems and report them. But we have efficiently and cost-effectively been able to sort out patients who are not currently at risk. Those who have masses or cancer can often go right to surgery, as we already have the CT images needed.
I wish there were a way to deluge the CMS committee with real-life pressure to act now and not leave the aging population hanging another year or decade. Unfortunately, much of the problem lies with members of a silent medical community who go about their work and never make the effort to share their views or experience.
Can you believe that only 100 people from all across the country weighed in before Feb. 11 on the subject? Shame on us. We have the knowledge and the power, and we fail to use it to move the CMS mountain.
Tony Finch, MA, MPH
BodyView Diagnostic Scanning
To the Editor,
I just read your article about hospitals missing out on revenue due to outpatient imaging centers ("Hospitals lose out when imaging moves to private offices," published online Feb. 18 at www.diagnosticimaging.com/news). The article even stated that this was bad for the healthcare system. It neglected to address the fact that hospitals are reimbursed at a higher rate than outpatient facilities and charge substantially more. We offer services for people at a much more reasonable rate and, because of lower reimbursement, cost the healthcare system less overall. It's a win-win situation, especially for people who have no insurance.
Tina Cobb, RDMS, RVT
Lake Jackson, TX
Edgy NSF article may have gone too far
To the Editor:
I read with interest your article on nephrogenic systemic fibrosis and the "heavy collateral damage" that radiologists face due to the off-label use of gadolinium agents and subsequent development of NSF in some patients ("Radiologists meet with heavy collateral damage," December, page 23). While the points are largely difficult to dispute, I just want to note that there is a lot that we do that is off-label in interventional radiology, such as the way that stents are utilized (FDA concerns noted).
The rhetoric in the article is a bit inflammatory, suggesting that radiologists are to be shamed for ignorance or worse, when most are likely to be well educated and following standards of care that are taught by leaders and mentors in our fields. A similar type of discussion has been going on for some time now regarding ionizing radiation in CT scans, with polarizing viewpoints [expressed in ways] that at times seem more like pointing fingers than actually facilitating constructive dialogue. A toning down of the accusatorial commentary may be appreciated by some of your readers.
Jason Smith, M.D.
Department of Radiology
Loma Linda University
Loma Linda, CA
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