Put a Fork in Medicare’s Overtesting

With all the political angst over the future of Medicare and how to fund it, we have to ask: Why not start with eliminating the redundancies — the repeats on tests when no repeat is needed?

A new study published in the Archives of Internal Medicine suggests that Medicare patients frequently undergo repeated diagnostic tests. The researchers called such repetitive interventions a “major determinant” in the ability to contain health-care costs.

“We examined repetitive testing for six commonly performed diagnostic tests in which repeat testing is not routinely anticipated,” they wrote. “Although we expected a certain fraction of examinations to be repeated, we were struck by the magnitude of that fraction: one-third to one-half of these tests are repeated within a three-year period. This finding raises the question whether some physicians are routinely repeating diagnostic tests.”

Nearly three-quarters of a million older adults with fee-for-service Medicare coverage were studied. Within three years, the tests and their repeat numbers out of 100 Medicare patients were:

  • echocardiography (heart), 55;
  • imaging stress tests (heart), 44;
  • pulmonary function tests (lungs), 49;
  • chest computed tomography, 46;
  • cystoscopies (bladder), 41;
  • upper endoscopies (digestive tract), 35.

So nearly half (or more) of Medicare patients who had heart, chest, stomach or bladder tests had them again within three years. And the average time between repeat testing was four to 14 months.

Two different heart tests were analyzed. Echocardiography is an ultrasound of the heart, and is less invasive than imaging, or nuclear stress test, which tracks radioactive dye through the bloodstream to create the image while the patient works out on a treadmill or stationary bike, and again at rest.

As noted on Reuters, such procedures usually aren’t supposed to be repeated routinely. And the routine use of some (echocardiography, stress tests) are specifically contraindicated.

As Reuters makes clear, the tests studied are for diagnostic purposes; that is, they’re generally performed on people with symptoms to help doctors make a diagnosis, then decide how to treat the problem. They cost from about $200 to more than $1,000.

As the lead research told Reuters, “Either these patients continually develop new problems or there are doctors who routinely repeat tests. … The fact is, we are paid more to do more.”

Cost is not the only factor in having unnecessary tests; overuse can reduce the time available for practitioners to see new patients. As many Medicare beneficiaries are aware, it can be difficult already to find a doctor who accepts new Medicare patients. And as we’ve previously noted, unnecessary tests can lead to unnecessary and possibly complicating treatment for conditions that are harmless or relatively so.

As the researchers concluded, “Although the tests themselves pose little risk, repeat testing is a major risk factor for incidental detection and overdiagnosis
In an editorial accompanying the research study, Dr. Jerome P. Kassirer of Tufts University School of Medicine and Dr. Arnold Milstein of Stanford University School of Medicine wrote that “After decades of attention to unsustainable growth in health spending and its degradation of worker wages, employer economic vitality, state educational funding and fiscal integrity, it is discouraging to contemplate the fresh evidence … of our failure to curb waste of health care resources.”

To address unnecessary redundancies, the commentators suggest implementing peer-designed electronic systems to coordinate clinical information and eliminating incentives for fee-for-service procedures. The former would communicate a patient’s history more efficiently and the latter would pull the plug on the notion that more treatment means better treatment.

“No matter what future payment system is implemented,” wrote Kassirer and Milstein, “intercession in clinical decision making will be required to protect patients from too many tests and from too few tests. We have not come close to getting it right.”

If your doctor has prescribed a diagnostic test, either for the first time or especially as a repeat procedure, ask why; ask what would happen if you didn’t have the test, what it might show and what treatments might be prescribed for those hypothetical results.

You can also visit Choosing Wisely, an initiative to help providers and patients communicate better with the aim of more efficient delivery of health-care services. The site, produced by nine medical professional organizations, identifies procedures patients should question and discuss.

Patrick Malone & Associates, P.C. listed in Best Lawyers Rated by Super Lawyers Patrick A. Malone
Washingtonian Top Lawyer 2011
Avvo Rating 10.0 Superb Top Attorney Best Lawyers Firm
Contact Information