Today’s Managing Health Care Costs Indicator is 75,000 Saturday’s New York Times had a great example of using variation to identify waste in the health care system It’s almost never necessary to do two chest CT scans in a single day – one without contrast, the other with contrast. The ordering physician should know in advance whether she is looking for disease that requires imaging of the vasculature system. It’s bad to do sequential chest CT scans of patients for at least three reasons. Each chest CT scan is the equivalent of 350 chest x-rays – and we should avoid the extra radiation exposure, which does cause some cases of breast and lung cancer. The cost of CT scans is high – CMS reports that these duplicate CT scans cost Medicare alone $25 million. Doing extra tests poses the danger of finding “incidentalomas,” findings that are not relevant to health, but that require additional tests which pose new health risks and additional expenses...