Hospitals are getting much better at marketing themselves (see: Why and How Hospitals Should Market Themselves to Consumers on the Web). How about the marketing of hospital diagnostic services? Well, this would align with my opinion that the clinical labs and pathology need to establish a higher profile for themselves in the minds of consumers. How about discounted prices for screening imaging studies? Hmmmm! A recent article discusses this possibility (see: Hospitals Promoting Bargain CT Scans For Smokers)
Trumpeting a landmark study released recently, hospitals around the country have started offering deeply discounted CT scans for smokers worried about lung cancer. But some experts question whether the strategy is a marketing ploy that could bring more harm than good. St. Luke's Hospital in Bethlehem, Pa., put out a single-page flyer with a headline that a "10-second scan could be life-saving" and a clip-out coupon for a $49 procedure. University Hospitals in Cleveland has a slick video on its website promoting its $99 scan, noting that some experts say this could be the "new hope needed to help save lives." [These] hospitals [and others]....say they are responding to the study by the National Cancer Institute. It found annual low-dose CT...screening of asymptomatic current or former smokers could cut the death rate from lung cancer by 20 percent by identifying the disease earlier than X-rays....The nearly decade-long study of more than 50,000 current and heavy smokers showed 354 lung cancer deaths had occurred among those with CT screening compared to 442 deaths among those who were screened only with an X-ray....Hospitals have marked down the CT scan – which typically costs as much as $1,000 –to help cash-paying customers. The [screening] test is not covered by Medicare or private insurers. Neither the American Cancer Society nor the U.S. Preventive Services Task Force, an independent panel of medical experts that examines the effectiveness of preventive tests, has recommended the screening, although both groups are studying the issue....[E]xperts worry that hospitals pushing the low-cost CT scans will focus on promoting the benefits of the lung cancer study to patients rather than warn about its costs and complications. The biggest risk of the test is the possibility of false positives....Nearly one in four people in the national study had a false positive from the CT scans, which often can lead to a biopsy or other invasive procedures that carry their own health risks. Another concern is added radiation exposure from scans.
I understand the arguments of the naysayers about offering "inducements" for screening CT scans and the obvious risks of CT screening -- false positives and radiation exposure (see: Shift to Digital Mammography Results in Increased Patient Recalls; Confusion Caused by Conflating "False Positive" and "Overdiagnosis" in Breast Cancer). If I were running screening programs like those described, I would also restrict access to current or former, moderate to heavy, smokers; those with an industrial exposure to carcinogens; or perhaps even those with significant respiratory symptoms. I also would bet that many of these same patients would show evidence of other chronic diseases so that I might not stop with the CT scan. I would also include a simple set of lab tests including, for example, a lipid profile, also at discounted rates. All of this diagnostic screening falls under the heading of predictive medicine. For such a high-risk population, I believe that the problem of false positives can be addressed without any guilt whatsoever.
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