Imagine getting an MRI for an injury or suspicious pain and being incorrectly told you either do or do not have a serious medical situation. Either way, this can be a life-threatening, not to mention mentally anguishing, occurrence. Recently, a disturbing news story has come out regarding allegations of fraud against one of the nation’s largest MRI-reading companies, ProScan. The company is accused of letting physician assistants, who are not radiologists and are unqualified to read MRI imaging, “ghost read” MRIs. “Ghost reading,” in this case, is using a radiologist’s signature without the radiologist interpreting the radiographic studies, an act of fraud that may have caused injury to patients whose reports were incorrectly read.

While the alleged fraud is shameful, the underlying story is that the modern health care industry has a perverse incentive structure, in which insurance reimbursements drive the need to maximize the number of billable events, like office visits and procedures. This, in turn, encourages health groups to prioritize quantity over quality, and for clinicians to become proceduralists. In 2018, ProScan advertised that they had 35 board-certified radiologists on staff to read 350,000 studies per year, a physically impossible feat, according to the lawsuit.

Large health care centers have become people-processing centers, but a new movement has been underway. Concierge medicine, also known as direct primary care or boutique medicine, turns away from the mass-production variety of medicine. It removes the insurance-fueled financial benefits to large health care centers’ laser-focused efficient patient processing. It refocuses the physician’s efforts on maximizing the health of patients.

As evidenced by the ProScan debacle, maximizing efficiency to the point of impossibility results in errors. Patient advocates are needed now. What’s also needed is time: time for patients to spend with their doctors and time for physicians to speak with other physicians. Doctors who have chosen to practice direct primary care have embraced the opportunity to think differently about how to deliver old-fashioned relationship-based medicine while still embracing modern technology. Concierge medicine physicians understand the desire for patients to be heard, to be prioritized and to be treated like a person, not a number. And concierge medicine practitioners know that a diagnostic test is meaningless without a physician’s interpretation of its clinical significance.

One can only hope that dangerous practices like the ones that allegedly took place at ProScan will be swiftly caught and stopped. Unfortunately, it is likely that as long as insurance-driven financial incentives to maximize revenue exist, stories like these will not end. In the meantime, find yourself a concierge medicine doctor and start to enjoy a doctor-patient relationship that’s focused on you, not just the bottom line.

https://www.wcpo.com/news/i-team/whistleblower-lawsuit-accuses-proscan-of-fraud-misdiagnosing-patient-mris

About Kagen MD

If you live in or around the Park City, Utah area and want a doctor to treat you like you’re his only patient, contact Kagen MD. Michael Kagen MD is a direct primary care concierge doctor who offers unhurried appointments, convenient options for connecting with him and a desire to truly practice medicine in your best interest - not the insurance company. Contact him at (435) 633-6263 or https://www.kagenmd.com/location for details on membership options.  

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