Tuesday, February 3, 2009

Ultrasound as Physical Exam: Costs and Benefits

Will hand-carried ultrasounds be the new stethoscope, being used by every doctor as often as they take your pulse and listen to your heart sounds? The editorial "Should a Hand-carried Ultrasound Machine Become Standard Equipment for Every Internist?" in the American Journal of Medicine suggests that we are heading in that direction. According to the editorial the ultrasounds are "reasonable in cost, and highly accurate" and "have already increased the safety of many procedures". So what are the problems?

Who will train physicians so they know how to interpret what they are looking at?

Will it be like a stethoscope and therefore there will be no separate charge for its use? I am not sure physicians paying between $9,000 and $40,000 for the equipment (although costs will probably go down) would want to forgo payment for its use.

If there is an extra charge and it is used as routinely as a stethoscope, what will it actually cost an individual patient, how will it impact insurance premiums, and how will it impact the amount we pay in taxes that goes towards health care costs?

For all this money will it actually improve the outcomes of care?

The hand-carried ultrasound may improve care and if that is the case let's prove that with proper studies and start using it. Let's just not ignore the fact that we will need to be as creative in determining a payment system for it as were the doctors and engineers who have invented it.