Roanoke Times
Copyright (c) 1995, Landmark Communications, Inc.
DATE: THURSDAY, July 29, 1993 TAG: 9307290112
SECTION: NATIONAL/INTERNATIONAL PAGE: A-1 EDITION: METRO
SOURCE: R.A. ZALDIVAR KNIGHT-RIDDER/TRIBUNE
DATELINE: PHILADELPHIA LENGTH: Long
A heavyset 43-year-old electronics manager from the Philadelphia suburbs, Rzucidlo went for an MRI to see why his right arm and shoulder were in constant pain. But like maybe one in 10 people, he got claustrophobic in the enclosed, tube-like MRI scanner.
"I freaked out," he said.
His doctor found him a newer generation, open-type MRI. Getting into a conventional MRI scanner is like being loaded into a torpedo tube, but using the newer MRI is like slipping your body through a large, modernistic doughnut.
For Rzucidlo, it was no problem.
That kind of medical care has a "Star Trek" quality that satisfies patients and makes doctors feel like they can walk on water. But there's another side to it: It's breaking the bank.
More than greed, more than wasteful paperwork, more than the aging of the population, reliance on high-tech medicine is the fundamental reason the nation's $940 billion health care bill is rising nearly four times faster than inflation, according to many economists. MRI is just a small part of that.
The bottom line, economists say, is that the nation's health spending can be controlled only if the public eases up in its demand for the latest technology, regardless of the price. Otherwise, medical costs will continue to race ahead of overall prices.
In a sense, America is paying for leading the world in medicine. Innovations like the open-type MRI scanner are constantly pouring into the marketplace. Some - like MRI technology itself - are revolutionary. Most - like open-type scanners - represent incremental progress. They improve the quality of care for somebody, somewhere. And they cost money.
Harvard economist Joseph Newhouse estimates that as much as half the rate of increase in health costs is due to technological progress. Today's medical care costs so much because it's capable of doing so much. And that's the way people seem to want it.
But as health costs take up a bigger share of corporate and government budgets, it means less money is available for other pressing needs.
"Medical costs can't forever grow faster than the economy," said Newhouse. "At some point, the pain imposed when we have to give up other things to pay for health becomes too great."
Joe Rzucidlo never thought of himself as claustrophobic.
That is, until he went for an MRI to learn the cause of the shooting pains that weakened his right arm so he couldn't do his job at the electronics shop.
MRI - magnetic resonance imaging - uses a powerful magnet, radio waves and a computer to produce startlingly clear images of tissues deep within the body. It can locate a brain tumor or pinpoint a tear in a ligament without surgery or harmful radiation.
Rzucidlo first went to a hospital near his home in Trainer, Pa. The tube-like MRI looked like a tight fit. At 5-feet-11 and 290 pounds, Rzucidlo wears a size 54 jacket.
But he needed the test. His family doctor thought he had a shoulder injury; his orthopedist figured it was problem in his neck. The MRI would show what was wrong.
Rzucidlo lay down on the mechanical table. A technologist pushed some buttons and the table began moving into the tubular MRI magnet. Rzucidlo felt the cool, quiet confines of the machine enveloping his body. And then it happened:
His right shoulder brushed the side of the tube. His already-sore arm went into a painful spasm. Panic seized him.
"I couldn't breathe," he recalled. "It was like I was in a casket being buried alive." They had to get him out.
Then his family doctor found Rittenhouse Square Imaging, one of a handful of MRI centers in the Philadelphia area with an open-type scanner. Weary, pained and somewhat apprehensive, Rzucidlo decided to try again.
To his relief, the scans of his shoulder and neck went smoothly. He spent close to an hour in the doughnut-shaped MRP 7000 scanner, which is built by Hitachi.
"I probably would have gone to sleep if I weren't so hyper," Rzucidlo said afterward. And his problem? The scan showed it was a pinched nerve in his neck.
According to the industry magazine Diagnostic Imaging, there are more than 3,600 MRI scanners in the United States, a 20-fold increase since the technology was introduced in 1984. About half the MRI machines in the world are in America.
Rittenhouse Square Imaging - the center Joe Rzucidlo used - charges $950 a scan, including a radiologist's fee for interpreting the results. Herb Kressel, professor of radiology at the University of Pennsylvania Medical School, said MRIs can run from $800 to $1,400.
If you own an MRI machine, the money adds up rather nicely - as long as you keep the magnet busy. That's why Rittenhouse usually runs on a 12-hour day.
On a recent Monday, 11 patients were scheduled. Eight actually underwent scans. Of the three others, one didn't show up, another had no insurance and a third had a metallic clip on a blood vessel, which the magnet could have yanked loose with potentially lethal consequences. Her doctor sent her for a scan anyway, but the Rittenhouse staff refused to do it.
Rittenhouse manager Cindy Russell, who also is an MRI technologist, spends half her time marketing. She counts eight competing MRI scanners within a one-mile radius of her center in downtown Philadelphia. There are more than 60 in the metro area.
But Russell knows she has a selling edge. Not only can her open-type scanner take people with claustrophobia, it also can scan very heavy patients. Conventional MRIs have a limit of 300 pounds; her 17.5-ton machine has no limit.
"Why have another me-too scanner?" asks Russell. "This is here to scan patients who couldn't typically be scanned elsewhere."
If Russell's niche marketing works, Rittenhouse could turn a handsome profit for its owners.
David Higgins, president of DVI Inc., a California company that finances medical equipment and is the principal partner in Rittenhouse, estimates that a successful MRI center can generate $300,000 to $600,000 in yearly profit on a total income of $1.9 million.
MRI prices - and profits - have been slipping in the last couple of years. But until federal and state authorities cracked down, MRI was a bonanza for neurosurgeons, neurologists and orthopedists who set up imaging centers and then referred their own patients, many of whom really didn't need scans.
Because costly technology like MRI is irresistible to patients and doctors, most countries with national health systems carefully control its spread and use.
If no open-type MRI had been available, Rzucidlo's doctors had other tests they could have ordered. The results would probably not have been as definitive, but they might have sufficed.
Yet settling for second-best would mark a departure from the American way of health care. Patients in other countries accept limits - they may wait weeks for an MRI. But not here.
"You can say anything you want to, but our country is not going to put up with that kind of health care," said DVI's Higgins. "It's a quality-of-life issue."
Given a choice, said Rzucidlo, "I'd go with state-of-the-art medicine."
Dr. William Schwartz of the University of Southern California might be called the Marcus Welby of health care economists. As a physician with 30 years of experience in medical practice, he has a perspective that other economists lack.
"The policy makers have missed the point," said Schwartz. "Of course, we should try to get rid of inefficiencies. But the problem is that we are victims of our own successes as a biomedical research community. We're going to see at least the same rate of increase in costs due to new technology, wonderful technology, stunning technology.
"If I were to say to the American public, `I can cut your premium in half if you would let me go back and practice medicine the way it was in 1973,' I'm pretty sure nobody would buy into that."
To restrain technology-related costs, the government and the health system have a couple of options: one is to submit new devices and procedures to a rigorous cost-benefit test; another, to discourage the use of high-tech care in borderline cases.
The Clinton administration shrugs off the warnings of economists. White House officials say people like Joe Rzucidlo should rest assured. Their high-tech options will be preserved under reform.
But the economists don't buy it.
"There's basically a tradeoff between spending more and getting higher quality," said Burton Weisbrod of Northwestern University. "If we want to change that tradeoff and forego some improvements, we can hold down costs. But I know of no evidence that says we can have our cake and eat it."
by CNB