Re: Single ultrasound
From: ACF (evsono@pipeline.com)
Tue Aug 30 07:57:53 2005
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Dave Berck wrote:
> I don't suggest we stop prenatal care or screening for Rh
> sensitization etc. I do suggest that proper assessments of
> cost-effectiveness are few and far-between, and that modern medical
> practice is not driven by them (I think we all know this already). I
> don't suggest that we stop routine blood screening for Rh disease.
> Indeed it is quite rewarding to save those pregnancies. I only suggest
> that the costs involved (and these change all the time depending on
> cost of T&S, the cost of rhogam, ultrasound etc.) are incurred without
> regard to their merit relative to other health values society doesn't
> pay for. My point is that we don't have a ministry of health making
> these choices. These choices are driven by other factors -- good
> medical practice, inertia, tradition, patient desires, MD incentives,
> pharmaceutical marketing etc.
>
> */James Smeltzer <James.Smeltzer@wellstar.org>/* wrote:
>
> Hi!
> If you look at prenatal care, it is MAGIC! Evaluation of the
> content would lead us to question what in this is beneficial, but
> EVERY study that has looked at outcomes with vs without prenatal
> care has shown a clear pay-off of 3:1 or better, not to mention
> improved outcomes.
>
> When you talk about Rh Ig - the 28 week dose prevents
> sensitization in about 1% of potential pregnancies, about 1/2 of
> the treated ones, for a risk of 1/2%. Of these half will get
> pregnant again, or about 0.25% of doses will have a future
> preventative effect.
>
> A significantly sensitized pregnancy can run about $75,000 for all
> the testing and transfusions. I have to report a financial
> interest in these, as well as the fact that saving babies of
> sensitized mothers is the coolest thing I do professionally. With
> this seat of the pants assessment, Rh Immune globulin is cheap if
> it less than! $184 per dose (which it is). It is still better to
> prevent the problem than to treat it. Federal reimbursement must
> be close to actual cost at:
> J2790 Rho(D), immune globulin, full dose, human, injections, per
> 300mcg $93.54
> (http://www.zlbbehring.com/ZLBB/binary/Reimbursement_Alert_JuneJuly_2005_1.pdf)
> The potential for morbidity and mortality with (even the best)
> treatment makes this one a no-brainer, even though the cost of the
> full-court-press therapy af a sensitized mother is still cheap for
> cost of life saved by adult standards. My grandmother lost four
> boys from this before my mom was born. What was that heartache worth?
>
> Michale Parsons did a study with about the same results a good
> while back:
> http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=2154307&dopt=Abstract
>
> The sonographic assessment and screening of the cervix has
> probably saved enough in my practice from all the Neonatal
> intensive care costs avoided to pa! y for the entire ultrasound
> operation.
>
> So far, the only "undiagnosed" Down's Syndrome in this practice
> have been those who refused amnio despite multiple markers
> positive - with virtually NO help from serum screening - and this
> is all comers of all ages.
>
> I have no trouble defending most of what we do on a
> cost-effectiveness basis. I have no trouble offering one or two
> sonograms to the working poor at cost. Enoxyparin is an exception....
> ;^)
> Jim
>
> >>> evsono@pipeline.com 8/24/2005 5:12:16 PM >>>
> Prescripition Drugs For Neonates!!!
>
> art
>
> Joe wrote:
>
> > Dave: If we had a Ministry of Health I would hope that finally
> someone
> > would realize that the future of our country is in our newborns and
> > not on the old and dying on who we spend an enormous amount of
> money
> > for a few extra days of life. Doesn't make sense. But newborns
> don't
> > vote. Joe C
> >
> > Dave Berck wrote:
> >
> >> We may be de facto fiducial agents for our patients, but best I
> can
> >> tell the system is run exclusively by market forces. The
> lovenox is
> >> covered by plan A only because it's covered by plan B and for no
> >> other reason. Notions of "cost-effectiveness" seem entirely
> misplaced
> >> in American medicine. And let me tell you, I'd hate to have a
> >> cost-effectiveness analysis done on lots of standard
> >> medical/obstetrical practices, for example, 90% of ultrasounds
> that
> >> we do, virtually all of prenatal care, rhogam administration,
> >> diagnosis and management of gestational diabetes, most antepartum
> >> fetal testing, to name a few. They'd be pretty far down on the
> list
> >> of priorities for any Ministry of Health (if we had one) if a fair
> >> analysis were done.
> >>
> >> -- Dave Berck, MD
> >>
> >> James Smeltzer wrote:
> >>
> >> Hi Art!
> >>
> >> I just saw today a patient who was approved for enoxyparin
> >> (Lovinox-R) which has no proven superiority for Rx acute DVT in
> >> pregnancy over heparin. The former costs $2500 per month but has
> >> become the de facto standard of care. The latter is $78 per month.
> >> At term we have to switch back to heparin because of the shorter
> >> wash-out and possibility of epidural anesthesia. Is this indicated?
> >> WHo should pay the $2422 difference in cost?
> >>
> >> Physicians are de facto fiducial agents for their patients. Should
> >> we guide them in the appropriate use of their scarce resources? The
> >> rational indications for ultrasonography when the cost to the
> >> patient is zero may be different than that when the cost is
> full UCR
> >> price, and will be different for different patients f! or different
> >> reasons. The "my way or the highway" approach to medicine is wrong
> >> in a free society, IMHO, but then! I'm the guy who tapes on demand.
> >> About 1 in 4 patients actually NEEDS a sonogram for a medical
> >> problem in pregnancy... Unfortunately we often donot know which one
> >> of the four unless we do the scan....
> >> ;^) Jim
> >>
> >> >>> evsono@pipeline.com 8/12/2005 8:15:47 AM >>>
> >> bouthina ibrahim wrote:
> >>
> >> > THANK YOU JAMES NUMBER OF FETUS AND VIABLITY.
> >> >
> >> > */bouthina ibrahim /* wrote:
> >> >
> >> > LADIES ABOVE 35YS AND THOSE ITH PREVIOUS CONGENITAL ANOMALS EARLY
> >> > 11-14WS LOOK FOR NASAL BONE BRAIN SPINES AS THERE IS INCREASE OF
> >> > TRISOMY ESPECIALLY T21.AT 20WS SCANNING GENERAL BODY PARTS FOR
> >> > ASSOCIATED ANOMALIS.
> >> >
> >> > */James Smeltzer /* wrote:
> >> >
> >> > Hi!
> >> > Here in Georgia we are faced with the prospect of medicaid
> >> > cutting reimbursement for a normal pregnancy to one sonogram.
> >> > Our policy has been two for a normal pregnancy, with a 12-14
> >> > week dating, nuchal lucency and nose bone study, and a 20 week
> >> > anatomic survey. I can understand medicaid's need to ration
> >> > scarce resources with tax cuts and service increases,
> >> > especially when some practices are doing four or five
> >> > sonograms in a normal pregnancy.
> >> >
> >> > Which is most important for prenatal screening and diagnosis?
> >> >
> >> > Jim S
> >> >
> >> > James S. Smeltzer, MD, FACOG, SMFM
> >> > Consultant, Maternal Fetal Medicine
> >> > Wellstar Physicians' Group
> >> > ! Northwest Women's Care
> >> > 787 Campbell Hill St
> >> > Marietta GA 30060
> >> > James.Smeltzer@wellstar.org
> >> > VM 678-290-3035
> >> > Off 770-528-0260
> >> > Page 404-318-3451
> >> >
> >> > >>> evsono@pipeline.com 8/10/2005 11:41:14 AM >>>*Allen
> >> > Worrall wrote:
> >> >
> >> > > Unfortunately many large radiology departments cannot get the
> >> > > administration to spend the money! getting new machines,
> >> > space to put
> >> > > the machines, and doctors and sonographers to examine the
> >> > patients.
> >> > > Resources are often less than required, particularly when the
> >> > > radiology department is in a large hospital.
> >> > >
> >> > > I am sure Terry can expound on that subject much more than I
> >> > can.
> >> > >
> >> > > Allen
> >> > >
>> >> > > ----- Original Message -----
> >> > > *From:* Latha Natarajan
> >> > > *To:* Multiple recipients of list ULTRASOUND-HISTORY
> >> > >
> >> > > *Sent:* Tuesday, August 09, 2005 8:44 PM
> >> > > *Subject:* Re: consulting
> >> > >
> >> > > More number of cases, if unavoidable, should be tackled with
> >> > > more machines and the appropriate man-power.
> >> > > That is what my "guru" Dr. Suresh, mediscan sy! stems,
> >> > Chennai does.
> >> > >
> >> > &! gt; Logical solution.
> >> > >
> >> > > LN.
> >> > >
> >> >
> >>
> ------------------------------------------------------------------------
> >> > >
> ------------------------------------------------------------------------
> >> > >
> ------------------------------------------------------------------------
>> >> > > ----- Original Message -----
> >> > > *From:* Allen Worrall
> >> > > *To:* Multiple recipients of list ULTRASOUND-HISTORY
> >> > >
> >> > > *Sent:* Wednesday, August 10, 2005 8:11 AM
> >> > > *Subject:* Re: consulting
> >> > >
> >> > > Terry, I think I saw you at that lecture in Orlando, a GE
> >> > > supper event, in which a young woman radiologist from
> >> > > Boston,(I think) related that her ultrasound department was
> >> > > bogged down with too many cases, and one of the things that
> >> > > helped them was 3D ultrasound. The volumes can be obtained
> >> > > quickly, and looked at later by the radiologist.
> >> > >
> >> > > Has this speaker published her lecture anywhere? I thought it
> >> > > was very good and very thought-provoking.
> >> > >
> >> > > Allen
> >> &g! t; >
>> >> > ! > ----- Original Message -----
> >> > > *From:* Terry DuBose
> >> > > *To:* Multiple recipients of list ULTRASOUND-HISTORY
> >> > >
> >> > > *Sent:* Tuesday, August 09, 2005 6:27 PM
> >> > > *Subject:* Re: consulting
> >> > >
> >> > > Dr. De Lancer, you ask a question that many have asked.
> >> > > In general sonography (Abdomen and OB/GYN) usually no more
> >> > > than two an hour in peak rush times. It depends on how
> >> > > detailed the studies are, but at bottom line, two an hour
> >> > > average is too much if it is all day every day. This is
> >> > > based on my experience of 29 years and not on any
> >> > > scientific study.
> >> > >
> >> > > For you second question I would say anytime the
> >> >! ; > sonographer is rushed enough to not be able to focus on
> >> > > the diagnosis, that is too many. There needs to be a bit
> >> > > of fle! xibility to allow for the unexpected twins ! or other
> >> > > ! detailed study.
> >> > >
> >> > > Also do not forget that over work, continuously over a
> >> > > period of months or years can injure the sonographer.
> >> > > Repeated Stress Injuries are well documented now. See:
> >> > >
> >> > > http://www.sdms.org/msi/default.asp
> >> > >
> >> > > Hope this helps. Terry
> >> > >
> >> > > */jose de lancer /* wrote:
> >> > >
> >> > > Hi, i am Dr. Jose De Lancer from Dominican Republic.
> >> > >
> >! > > > I am obstetrician, gynecologist and sonologist.
> >> > >
> >> > > We have troubles in our hospital sonografy department
> >> > > for the "overdemand" in ultrasound studies.
> >> > >
> >> > > What is your opinion in the following isues:
> >> > >
> >> > > 1-How many studies are reasonable for each sonographer
> >> > > in one day?
> >> > >
> >> > >! 2-How afect the excesive number of patients in the
> >> > > individual and department quality?
> >> > >
> >> > > Thanks for your cooperation!!
> >> > >
> >> > > */"DuBose, Terry" /* escribió:
> >> > >
> >> > > Congratulations to everyone on another landmark
> >> > > event. Good work. Terry
> >> > >
> >> > > Terry J. DuBose, M.S., RDMS, FSDMS, FAIUM
> >> > >
> >> > > Associate Professor & Director
> >> > > Diagnostic Medical Sonography Program
> >> > > University of Arkansas for Medical Sciences, CHRP
> >> > > 4301 West Markham St. Mail Slot #563
> >> > > Little Rock, Arkansas, 72205 USA
> >> > > 501-686-6510
> >> > > DuBoseTerryJ@UAMS.edu
> >> > > http://www.io.com/~dubose/
> >> > >
> >> > > http://www.uams.edu/chrp/dms/default.asp
> >> > > http://www.obgyn.net/us/panel/panel.htm
> >> > > ---------------------------------------------------------------
> >> > >
> >> > > ---------------------------------------------------------------
> >> > >
> >> > > ---------------------------------------------------------------
> >> > >
> >> >
> >>
> ------------------------------------------------------------------------
> >> > >
> ------------------------------------------------------------------------
> >> > > *Fro! m:* Dale R. Cyr [mailto:cyr@ardms.org]
> ------------------------------------------------------------------------
> >> > > *Sent:* Tuesday, August 09, 2! 005 7:18 AM
> >> > > *To:* ALL STAFF; BOARD MEMBERS; All EDTF Committees
> >> > > *Cc:* Thomas Magallanes; steve_tapp@promissor.com
> >> > > *Subject:* Success in Hong Kong ARDMS Exam Delivery
> >> > >
> >> > > Hello Everyone:
> >> > >
> >> > > ARDMS began delivering examinations at the
> >> > > University of Hong Kong on August 8th. Two
> >> > > candidates sat for ARDMS examinations (Neuro and
> >> > > CPI), which were routinely and securely delivered
> >> > > with all data safely transmitted back to
> >> > > Promissor as per normal procedure. The ARDMS Hong
> >> > > Kong exami! nations and processes are exactly the
> >> > >! same as here in the United States and Canada.
> >> > > Several other Candidates are scheduled to sit for
> >> > > ARDMS examinations in Hong Kong over the next
> >> > > couple of weeks.
> >> > >
> >> > > Congratulations everyone as ARDMS continues to
> >> > >! increase the number of credentialed individuals to
> >> > > promote qual! ity and patient safety through
> >> > > credentialing and continuing competency of
> >> > > ultrasound professionals.
> >> > >
> >> > > Also, a big thank you to Promissor who has been a
> >> > > great partner in assisting ARDMS in meeting our
> >> > > strategic initiatives, particularly in the global
> >> > > expansion program.
> >> > >
> >> > > Regards,
> >> > >
> >> > > Dale
> >> > >
> >> > > Dale R. Cyr, MBA, CAE
> >> > >
> >> > > Chief Executive Officer/Executive Director
> >> > >
> >> > > ARDMS and the Breast Ultrasound Foundation
> >> > >
> >> > > 51 Monroe St., Plaza East One
> >> > >
> >> > > Rockville, Maryland 20850-2400
> >> > >
> >> > > 301-738-8406, x223
> >> > >
> >> > > cyr@ardms.org,
> >> > > cyr@breastultrasound.org
> >> > >
> >> > > http://www.ardms.org
> >> > > http://www.breastultrasound.org
> >> > >
> >> > > //You should always make sure. Verify the Registry
> >> > > status of employees - current and potential.
> >> > > ////ARDMS offers an _online directory of its
> >> > > Registrants.
> >> > > _//////
> >> > >
> >> > > *NOTICE:* This e-mail may contain information that
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> >> > > Espacio para todos tus mensajes, antivirus y antispam
> >> > > ¡gratis!
> >> > > Regístrate ya - http://correo.espanol.yahoo.com/
> >> > >
> >> > Allen
> >> >
> >> > Falling reimbursements and rising expenditures is not an optimal
> >> > business model.
> >> >
> >> > Art
> >> >
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> >> James
> >>
> >> One of the specious exercises in medical logic today is
> "practice by
> >> insurance." If a physician feels a procedure or scan is medically
> >> indicated, then it should be performed. Conversely, if it is NOT
> >> indicated, then it should NOT be performed. To the best of my
> >> knowledge,
> >> the fact that a procedure is covered by insurance is not
> >> pertinent to
> >> what should be medical decisions.
> >>
> >> Just my opinion - I could be wrong.
> >>
> >> Art
> >>
> >> >>>>>>>>>>>>> Confidentiality Disclaimer <<<<<<<<<<<<<<<<
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> you.
> >> ================================================================
> >>
> >> David J. Berck, MD, M! PH
> >
>
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> David J. Berck, MD, MPH
And not the least of these ... Litigation concerns.
Art
