More volume, more problems?

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Evan Godt, staff writer

As the U.S. healthcare system prepares to absorb an influx of new patients, one of the top stories from this past week revolved around one hospital’s work to expand services to a growing patient population.

Baltimore Veterans Affairs (VA) Medical Center expanded its mammography screening program in 2008 as part of effort to recognize the changing face of VA patients. Between 2003 and 2009, the number of women utilizing outpatient services at a VA facility had jumped 47 percent, reflecting the growth of women in the armed forces in prior years.

While the expansion of screening was designed to identify women with breast cancer so that they might receive treatment at an earlier stage, the results of a retrospective analysis revealed a bottleneck in care that was actually increasing time from diagnosis to treatment.

After the 2008 expansion of screening, Baltimore VA saw a 1,200 percent increase in annual mammography utilization and a 48 percent increase in the number of patients receiving cancer treatment each year.

This growth didn’t affect time from screening to tissue diagnosis—that remained steady at 34 days before and after the expansion—but the time from tissue diagnosis to definitive treatment increased from 33 days to 51 days post-2008.

Study authors Charlotte L. Kvasnovsky, MD, from Baltimore VA Medical Center, and colleagues noted that more than 86 percent of patients received care between multiple institutions and speculated this may have had something to do with the delay in treatment. The expansion of screening services was a success in that more cancers were being spotted, though there was an increased need to utilize non-VA-based resources. They suggested the hospital should work to increase the number of on-site breast care services offered, rather than referring patients to outside resources.

This story could be a kind of microcosm for the healthcare system as a whole. The Patient Protection and Affordable Care Act is set to swell insurance rolls by adding 27 million people by 2017, according to the Congressional Budget Office. In addition, the U.S. population is aging, which means more services will be required.

Expansion of care is a wonderful thing for those that had lacked access, but providers need to be anticipating the challenges they may be facing. Now is the time to evaluate processes, streamline workflows and make sure resources are being utilized in the most efficient manner possible.


Evan Godt
Editor – Health Imaging