An MRI, or a fleet of cars: High healthcare prices

Of the cars I've owned over the years, my favorite was my homely first car, a pale yellow 1976 Ford Maverick with a lime green interior, which I bought, very used, from a good friend, after it had run 113,000 miles. The purchase price in 1985: $325. The car wasn't pretty, but it was rugged, and served me well.

My mother recently had an MRI in an Atlanta hospital as an outpatient. Thankfully, the MRI helped to rule out a serious condition, and she promptly got back to 100% health after a course of antibiotics. The hospital billed her Medicare plan $3,200 for the 10-minute test! The price tag was so high that I struggled to find an appropriate yardstick: it was enough to buy a fleet of ten Ford Mavericks.

When prices are that high, something has to give; not everyone will have insurance that covers such tests, and some will go without care, usually people who lack excellent insurance.

He got it for free: A decision by Mariano Rivera on elective shoulder surgery

Mariano Rivera stepped out of the visitors' clubhouse in Boston's Fenway Park on Friday to get a soft serve ice cream cone. It cost $4.25, but he got it for free. At 38, after a long career, he is well known, and being the greatest closing pitcher in baseball history has its perks.

He is weighing the merits of shoulder surgery for inflammation caused by a calcification in his right shoulder. It causes him periodic irritation and pain, intensifying when he pitches frequently, but has not prevented him from having 38 saves in 39 chances this season, with 76 strikeouts and only six walks.

He had an MRI (magnetic resonance imaging) test, and saw two doctors this week, who have given him the options of cortisone injections to dull the inflammation, or surgery. The surgical procedure would be a minor one, requiring only a few weeks of rehabilitation.

He is weighing his dislike of needles against the low risks of surgery, and is leaning toward surgery.

Advice to athletes considering surgery: Keep in mind that the team physician and other employees of the team have the team’s best interests at heart, not necessarily yours.

Read another story on a baseball pitcher.

Thanks to Tyler Kepner for the source story in today's New York Times.

Now they take pictures at Disneyland, not to Disneyland: Personal Health Record

Aaron Walbert is a teenager living in Colorado Springs, an hour and a half from his doctors. He has vacationed in northern Minnesota and in Disneyworld. He can use a computer like most members of his generation.

He has an exceptional past: in his fourth day of life, he suffered a stroke, and developed hydrocephalus. Since then, he has undergone numerous operations to drain the excess cerebrospinal fluid, via a shunt. While on vacation several years ago in northern Minnesota, he began complaining of headaches and nausea, making his mother worry that his shunt had malfunctioned. At the hospital in Duluth, two hours away, no one could retrieve his chart from his Colorado hospital. He had to drive 3.5 hours away to another hospital so a neurosurgeon could determine whether surgery was needed. Over time, his mother has realized there are many false alarms, because everything from the flu to a poor night’s sleep can mimic the failure of a shunt. Even so, she began to lug around the large, heavy envelopes of radiology films wherever they went, out of concern that the shunt could fail at any time.

But this hasn’t been necessary for the last two years. The Walberts acquired an electronic personal health record (PHR), so they could access his health records anywhere. If Aaron gets sick far from home, doctors at the nearest hospital can download his latest MRI scan for comparison. And they could have anything else in his medical record at their fingertips. That was helpful two years ago, when Aaron got sick at home. Mom took him to a local radiology office for a brain scan, and had it compared to the most recent scan, available online via the PHR. When the doctor realized the scan was unchanged, Mom could bring him home without worry, without making the long drive to his hospital.

Advice to rural families with complex medical needs: Get a Personal Health Record. Having your up-to-date medical information on hand anywhere can be a godsend.

Read a story of how a wife’s medical information on her husband saved him, or read Dr. Orly Avitzur’s story in Neurology Now.

Who's on films? What's on second?: An MRI Error

A member of our family--call him Javier--told me his story:

I noticed a bump on my arm, and saw a hand doctor for it, because it wasn't normal. He ordered both an X-ray and MRI. He also referred me to a specialist, who would read them for me.

I waited for the appointment. The day before, I called to confirm that the specialist had received the MRI films, and someone in the office had said Yes. The next day, I showed up for my 8:30 am appointment, and the receptionist asked me if I had the films. I said No, since I had called the day before and someone had told me the films had been received. I then waited a few hours.

I was finally taken into the room to see the doctor, and his assistant asked me if I had my films! Then two other people looked for them, and left. A supervisor then came in and asked me the same questions.

Finally the doctor came in with the film search party, and told me they did not have the films, and that he would prescribe me another MRI. He ordered another MRI, which I had about a week later. But I couldn't get an appointment with him for another two months--he was so busy!

By then, the bump was going away by itself. At the appointment, he said the MRI was OK. I was fine.

But the story wasn't over. He billed me for both sets of MRI films, and my insurance paid for both of them. Now the doctor's office is going after me to pay for the visit where nothing happened, except that the film search party spent a few hours looking for the films while I waited.

So now I have to spend time arguing about the bill! And all I got for it was two months of worrying that I had cancer, and a bump that wasn't treated--and I got to wait in his office, too--and the chance to talk, probably several times, with the doctor's office staff to straighten this out.

Read another story of misplaced diagnostic test results.