IMAGIN(EIN)G: SAVING MONEY

I think people can save a significant amount of money on their health care even if they don't have health insurance. Imaging studies (CT scans, ultrasounds, MRIs) can be one of the largest health care expenses. This week I will tell you how to save money on them.

Independent imaging centers such as Indianapolis based CDI (Center for Diagnostic Imaging) charge on average 30% less than hospital-based radiology departments. Free price quotes can be obtained by calling 1-800-537-0005. They provide the same high-quality studies and (in my experience) often provide better and faster service.

The heart scan screens for coronary artery disease. The price of this can vary from $49 locally to $29 at Reid Hospital in Richmond. Your doctor can help you determine if this test would be beneficial to you versus a much more costly cardiac stress test.

A common expense can be a followup of an abnormal chest x-ray. A repeat exam in 3 months is much cheaper that an immediate CT scan and is often a reasonable alternative depending on the abnormality.

Mobile screening units offer a limited amount of low priced imaging studies (carotid artery ultrasounds and aortic aneurysm screens). I would caution you to discuss with your doctor which tests are appropriate for you rather than just doing all of the tests offered.

Screening mammograms are offered by many hospitals at a reduced rate around Mother's Day and during breast cancer awareness month in October. Certain patients can also qualify for free ones through a grant from ICAP at 765-529-4403.

Let your doctor know if an imaging study would be a significant financial burden to you so alternatives can be discussed. If you're willing and able to drive a little, you can save a lot.

ACCEPT NO (LESSER TRAINED) SUBSTITUTE

I think that being cared for in the hospital by a nurse practitioner instead of a doctor is unacceptable. The breath of depth of training between physicians and nurse practitioners are immense.

A board-certified Family Physician will have up to 1700 more lecture hours, 1500 more study hours and 10,000 more residency hours than a nurse practitioner. Advance clinical care constitutes only 33% of the curriculum for nurse practitioners.

Family physicians complete training for complex differential diagnoses and medical treatments. A nurse practitioner is trained to recognize and treat common conditions.

You know what you are getting with a board-certified Family Practice doctor since they must complete an accredited training program and pass a standardized exam to become board-certified. The requirements are the same in all 50s states.

A nurse practitioner must complete a training program that varies from state to state without any nationwide standardization. Only 38 states require them to hold a masters degree and those states grandfathered in those who called themselves nurse practitioners prior to 2008 whether or not a Masters degree was ever completed.

Physicians are taught by other physicians to learn what is needed to provide quality care to a hospitalized patient. Nurse practitioners or taught by nurses to attempt to learn what is needed to provide quality care to hospitalized patients.

That is like having a flight attendant train another flight attendant to act as a pilot. I am sure they are intelligent, hard-working and kind but I don't want them to fly my plane and I don't want a nurse practitioner taking care of me in the hospital.

WHY YOU SHOULD CHOOSE A HOPITA(LAST)

I think when people are at their sickness (in the hospital) they want to be cared for by the doctor who knows them best. This is becoming an option available for fewer and fewer people nowadays both locally and nationally.

The concept of the hospitalist specialty is to have a doctor who only takes care of patients in the hospital. No care is provided in an office setting and no long-term doctor/patient relationship exists.

The theoretic advantages include having a doctor always available on site to immediately address test results and changes in the patient's condition. This arrangement should be able to save money by allowing patients to be discharged to home sooner.

The disadvantages include having a doctor who doesn't know the full, often complex, history of the patient including prior evaluations and treatment. Upon the patient's release, the family doctor often does not know what transpired during the hospitalization and what followup is needed.

Not surprisingly, the theoretic advantages have not materialized. Recent studies show that any cost savings from an earlier release from the hospital in patient's cared for by hospitalists are more than offset by the expense of additional ER visits and readmissions to the hospital in the month following discharge.

It seems to me that under the guise of "focusing on outpatient care ", family practice doctors who choose not to care for their hospitalized patients are abdicating their professional responsibility. I would not choose a doctor that was only committed to my healthcare while they are in the office 6 hours a day, 4 days a week. But maybe that's just me.