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