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03/02/2013    Wm. Barry Turner, BSN, DPM

Diagnostic Tests in the New Healthcare Environment

A year or so back, I found I was unable to order
WBC-tagged bone scans to differentiate a
diagnosis of osteomylitis, from a possible
Charcot event. When I contacted my local
hospitals nuclear medicine department, I was
told that the Medicare-approved payment was less
than half of the procedure cost and the
hospitals could no longer afford to provide this
service.


I acknowledge that most radiologist will tell
you they can differentiate between Charcot and
Osteomylitis with an MRI, but you must keep in
mind that the MRI is a static test, where the
WBC-tagged bone scan is a dynamic test. The
limitation with the MRI is that the procedure
can not really judge an infection. The MRI may
reveal bone loss and intermedullary edema, but
it can not tell if there is a decline in WBC
activity. So long after the infection is
resolved, the MRI may still show active bone
edema and be misinterpreted as active infection.


Yesterday, I was called by my local hospital's
lab department supervisor. The lab requested I
refrain or restrict my request for homocystiene
levels and MTHFR. It seems that recently
Medicare had determined it cost-efficient to pay
the hospitals less than the hospital's cost to
perform the test. Roughly 50%


If you read the current literature regarding
MTHFR, treating the condition in adults and the
elderly, will most likely not influence their
life span, but the results can be used to
provide genetic counseling and by treating the
children and grandchildren of your patients, may
actually allow you to add years to these young
persons lives. My office patients that have been
tested for the double gene defect (positive
genetic defect) ratio is much higher than is
reported in literature, running about 70%.


But, alas, those who are in power know so much
more than us peons, have deemed the MTHFR test
to the basement, as they have done before with
so many other needed diagnostic and treatment
modalities.


Where is this leading healthcare? Is the general
population of our great land aware how not just
the cost of healthcare is being manipulated, but
also the quality?


Wm. Barry Turner, BSN, DPM, Roston, GA,
claret32853@ymail.com


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