Special Guest inHealth Blog Entry: The $2.7 Trillion Medical Bill

Cancer screening of asymptomatic, but at risk, individuals is a basic tenet of cancer health services – early detection saves lives. Costs are certainly part of the equation and a point in the triangle of timeliness, quality and cost, which usually accepts that one can accomplish two of these to the neglect of the third. In the era of electronic medical records, computer assisted health care reminders and provider checklists, and the proactive patient however, we might now expect to address these three factors in cancer screening simultaneously.

The NYT article  points to wide variation in the costs of colonoscopy as factor in our national travesty of higher costs and less health. Rosenthal points out that individual insurers can take steps to manage the cost of individual tests, much as Maryland Department of Health and Mental Hygiene has done with modest reimbursement for colonoscopy screening and observed in Baltimore City, which had the lowest per colonoscopy charge among the cities reported. 

Nevertheless, cost is but one aspect of the effort to intelligently screen. If colorectal cancer screening was done at United States Preventive Services Task Force recommended intervals, and high service quality was enforced, we would maximize cancer screening dollars. As noted in the NYT article, patients may be urged by their doctors to overindulge in these preventive measures by getting tests at shorter intervals or at younger or older ages when there are fewer benefits and more risks. And other patients without sufficient means may forego the tests altogether. A poor quality colonoscopy will precipitate additional, and in a sense avoidable, exams.

The high price tag today of colonoscopy is not so different from the market expansion of clinical mammography that predominated in the late ‘80s and early ‘90s. Clinical testing gave way by the mid ‘90s to a bona fide screening mammography suitable for asymptomatic women. 

This is where the inCaS component of the Johns Hopkins Individualized Health Initiative (inHealth) enters.  inCaS seeks to optimize cancer screening in our patients and covered lives by bringing together experts from the Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, the Bloomberg School of Public Health, the School of Medicine, Johns Hopkins Healthcare, and Johns Hopkins Community Physicians. The inCaS team is working to assure appropriate and high-quality cancer screening for all. 

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