Byline: JEREMY COX
What a difference 70 miles can make.
An older woman is five times more likely to get called back for a follow-up mammogram at Flagler Hospital in St. Augustine than at Southeast Georgia Health System's St. Marys Hospital.
Which is ordering the right amount of medical imaging for breast cancer? Perhaps neither.
Doctors order a second test in about 17 percent of cases at Flagler and about 3 percent of the time at St. Marys. If a hospital's follow-up rate with older women is much lower than 8 percent or higher than 14 percent, that may be a sign of an operational problem, Medicare officials say.
Federal officials released data last week that shed light on a previously dark corner of medicine: medical imaging. By publishing statistics on how often doctors at hospitals order CT scans, MRIs and X-rays, officials say they hope to discourage overuse of radiation.
"It at least lets them know they're out of the norm from their colleagues" and that they should investigate the cause, said Barry Straube, chief medical officer of the Centers for Medicare and Medicaid Services, which released the figures.
Unnecessary imaging drives up medical costs - a huge concern for Medicare, whose annual budget accounts for about $1 out of every $8 spent by the federal government. And experts say radiation from medical tests raises patients' cancer risks down the road.
Many factors may contribute to overuse of radiation, said Richard Morin, a researcher at Mayo Clinic in Jacksonville and chairman of an American College of Radiology radiation safety committee.
Some were trained to perform more tests than what is generally accepted now. Others may order a test to ward off a potential lawsuit. And then there is what Morin calls "entrepreneurial medicine" - doctors steering patients to equipment they own for the sake of profit.
But physicians aren't necessarily the only ones to blame, Morin added.
"Patients come in and say, 'I want an [MRI].' And they'll go to another doctor if they don't get one," he said.
Arif Kidwai, a general radiologist at Flagler, said he is comfortable with the amount of breast imaging he and his colleagues perform at the St. Augustine hospital. He cited a number of factors for the high percentage of follow-up mammograms: an older Medicare population; exclusive use of digital mammography, which detects cancers in the earliest of stages; and a computer-aided diagnosis system.
A study involving five radiologists and 185 patients showed that there were 5 percent to 7 percent more callbacks using the computer-aided technology.
Mandy Dazani, Flagler's director of mammography, said that it's "worth it" to have a "slightly higher rate" of follow-up mammograms if it means more tumors are caught.
Flagler's mammography callback rate was the highest in Northeast Florida and Southeast Georgia, according to the Medicare data, which was published last week at www.hospitalcompare.hhs. gov. The next-highest was a full percentage point lower, with Wayne Memorial Hospital in Jesup, Ga.
Southeast Georgia Health System's St. Marys facility, which had the lowest rate in the region, released a statement in response to The Times-Union's questions: "We support the transparency of information and making this data available to the public. However, the percentages that you reference on Hospital Compare are efficiency rates only and do not reflect the quality of patient care at Southeast Georgia Health System," it said, in part. …