Some community hospitals are already claiming to have changed their policies after a report found hundreds of hospitals routinely use a type of CT scan that subjects patients to double the typical radiation dose.

A Washington Post/Kaiser Health News Report published Saturday using Medicare data from 2008 found more than 600 hospitals use a double CT scan on at least one out 10 Medicare chest patients.

The double CT scan gives patients both a contrast and a non-contrast scan, although most radiologists believe a single CT scan is all that's required for most patients.
Experts worry that the possibly excessive use of double CT scans could lead to increased patient exposure to radiation and could burden Medicare with millions of dollars in unnecessary costs. In a report last week, the Boston Globe said a single CT scan delivers the equivalent radiation dose of about 350 chest X-rays. And in 2008, double CT scans at hospitals cost Medicare nearly $25 million.

That said, the median rate for Medicare double CT chest scans in 2008 was rather low, at 2 percent of Medicare patients. Still, more than 76,000 Medicare patients getting chest CT scans in 2008 - or 5.4 percent of such patients - received double CT scans. And quite a few hospitals were high users. Around 618 hospitals use it on 10 percent of patients, while 94 hospitals used it on half of Medicare chest patients.

Rates for patients with private insurers weren't included in the report, but the Post cited a Minnesota-based HMO, HealthPartners, which said one out of 14 chest patients received double scans last year.

Hospitals respond

Critics worry that because Medicare pays more for double scans, hospitals don't have a strong incentive to find ways to reduce them. The combined hospital and radiologist fee paid by Medicare for double scans is $403, versus $362 for a contrast scan and $245 for a non-contrast scan, according to reports.

But since the data were collected in 2008, some hospitals have said they've instituted new training programs or scanning protocols, and have seen double-scanning rates plummet.

According to a map developed by the New York Times, Ashland Community Hospital in southern Oregon performed the double scan on 40 percent of its Medicare chest patients. But a hospital spokesman told Ashland Daily Tidings that in the past year and a half, it has lowered the double scan rate to 2.5 percent of all patients, in line with the national median. (However, the hospital was not able to provide the newspaper with figures for only Medicare patients.)

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