LIFELONG HEALTH

Unneeded medical tests bloat health-care costs

Medical tests are valuable, but when done for no good reason, they waste money.

A study published in June in the Journal of the American Medical Association reported that cholesterol measurements were obtained too frequently in patients with known heart disease.

Of a total of 35,000 heart patients at the Houston Veterans Affairs Network, 28,000 were treated with medications to lower cholesterol. Of these, approximately one third had more than one cholesterol measurement over an 11-month period despite being stable with no medication changes. Standard care suggests no more than one measurement annually.

These unnecessary tests, totaling 13,000, cost this VA system more than $200,000.

In an accompanying editorial, Dr. Joseph Drozda Jr. points out that the costs of these inexpensive tests add up quickly. The experience at the VA in Houston occurs at hospitals nationwide, adding billions to health-care costs.

Meanwhile, many other blood tests are performed for no good reason, and repeated too frequently. If done on the basis of sound scientific evidence of benefit, the cost savings would be enormous without affecting quality of care.

Why are unnecessary tests ordered? At the VA there is no profit motive in doing unneeded tests. Here testing may be done because monitoring cholesterol is used as a performance measure of quality care. Showing that you are industrious about compulsively attempting to obtain target cholesterol levels in patients with heart disease may be rewarded with end-of-the-year pay raises or bonuses.

As 2014 approaches and the Affordable Care Act becomes a reality, we must all pitch in to assure the highest possible medical care at a reasonable cost. It is said that as much as half of the $3 trillion health-care budget is consumed by unnecessary medical care and bloated and excessive administrative costs.

There is not a single aspect of health care that is not to blame. Over prescribing medications is a serious concern,as is using expensive newer drugs over generics that work just as well. Too many tests are ordered, including routine blood measurements, X-rays, CAT scans and MRIs. Screening tests for cancer are done too frequently and continued beyond the age when no longer recommended. Too many diagnostic biopsies and surgeries are not needed and done when more conservative approaches are proved to work just as well.

Patients make unnecessary appointments with specialists (their insurance plans are proud that “referrals to a specialist is not needed”). Communication among doctors is inadequate; many physicians follow the same patient too frequently, repeating tests already done by others. Lack of communication and duplicative care by multiple physicians lead to uncoordinated and dysfunctional care.

Not a day goes by that I do not see patients who in my view have been inappropriately treated. Here are some examples.

Many patients with well-controlled high blood pressure or heart disease go to their cardiologists and have stress tests, echocardiograms, screening of their carotid arteries and even angiograms despite the fact that they are stable with no new complaints. Unless symptoms occur, taking these tests as a routine is of no proven value. A patient I saw recently told me he received a bill of close to $20,000 because of tests that were not needed and did not alter his care.

Another example is a man of 85 who received a PSA to screen for prostate cancer. The American Urological Society states that at his age, this test should not be done. Because his PSA was elevated, further testing was recommended. Wisely, he refused a biopsy but was treated with medications to eradicate his testosterone level. At his age, this led to forgetfulness, severe weakness, fatigue, osteoporosis, difficulty walking and a poor quality of life.There is no evidence that the treatment he received would prolong his life or cure his cancer, if he had any.

And I will never forget the robust 78-year-old woman who paid $125 to receive a CT scan to screen for coronary artery disease. Totally symptom free, she was told that open heart surgery was essential. As a consequence of complications, she spent the remaining years of her life in a nursing home.

Not only is the need for surgery in an asymptomatic woman of this age highly questionable, but a CT scan should not have been done.

We should all be aware of unnecessary and unneeded care. Not only is it breaking the bank, the consequences can be truly nightmarish.

Dr. David Lipschitz is co-director of the Healthy Aging Center at Saline Memorial Hospital. More information is available at: drdavidhealth.com

High Profile, Pages 35 on 07/14/2013

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