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nytimes.com
An M.R.I. Machine for Every Doctor? Someone Has to Pay
By REED ABELSON
Published: March 13, 2004
Chris Rank for The New York Times
Dr. Patrick J. Lynch, a radiologist, complains that many specialists are investing in M.R.I. machines as a way to increase their incomes.
SYRACUSE — This aging city is an unexpected epicenter for a high-tech medical arms race. But employers and insurers here say that is just what they are paying for, as doctors, their traditional sources of income squeezed, discover a new one: diagnostic imaging.
Instead of sending patients to a radiologist or one of four local hospitals, doctors in Syracuse have been particularly aggressive about installing imaging equipment — particularly M.R.I. machines — in their own offices.
Nationally, diagnostic imaging, which also includes CT and PET scans, is approaching a $100-billion-a-year business, according to a recent report by the Blue Cross and Blue Shield Association, using estimates from the consultant Booz Allen Hamilton, up about 40 percent just since 2000.
Indeed, while insurers have long paid the greatest attention to the rising costs of drugs and hospital stays, they are becoming increasingly concerned about imaging. "There's so much entrepreneurship here that is superseding what is truly needed," said Dr. Allan Korn, the chief medical officer for the Blue Cross and Blue Shield Association. "It's becoming a huge problem."
In the Syracuse area, the number of magnetic resonance imaging machines has grown by a third over the last three years. In the 12 months ended last June alone, use of M.R.I. scans in the area increased 23 percent, according to National Imaging Associates, a company that works with insurers to manage costs.
Competing hospitals and radiologists complain that the imaging upstarts — orthopedic surgeons, cardiologists, neurologists and others — are performing services that the radiologists say they do better and that the hospitals say they already provide. They also point to a regulatory environment, on the state and federal levels, which restricts their business but, they say, gives the new competitors free rein to expand.
No one disagrees that much of the recent growth in diagnostic imaging is a result of medical advances that allow doctors to better discover what is wrong with a patient or to avoid more invasive procedures, like exploratory surgery. And many patients prefer not having to leave their doctor's office to get an M.R.I.
"This is nothing more than changing times — we have to change," said Dr. I. Michael Vella, the president of Syracuse Orthopedic Specialists, the largest orthopedic surgery practice here, with 23 doctors in eight offices across Syracuse.
In a building at the edge of a shopping mall that the practice renovated last summer into its main office, the doctors have installed two M.R.I. machines and a nuclear camera, equipment made by General Electric that costs millions of dollars. <continued> |
