The New York Times' reliably good Gina Kolata wrote a piece Monday showing how far evidence-based medicine (or maybe common-sense-based medicine) has to go. In Good or useless, medical scans cost the same, she talks about a woman whose MRI scan was blurry and useless: "Her insurer refused to pay for another scan, but the doctor said he was sure she had torn cartilage that stabilizes the knee and suggested an operation to fix it. After the surgery, [the patient] ...received a surprise: the cartilage had not been torn after all." Why should an MRI provider be paid for an "uninterpretable" scan? How much money, time, and other resources were wasted on that surgery, and how much unnecessary pain did it cause?
Where's the incentive to do better? Kolata says "Insurers pay the same for a scan done on a 10-year-old machine as one on the latest model, though the differences in the images can be significant. Insurers do not distinguish between scans that are done poorly or done well or read by less- or more-qualified doctors." If insurers won't provide an incentive for people to improve the quality of the medical evidence they are producing, who will?
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