More tests = more money
Anyone who has read my blog over the years knows this is a subject I come back to again and again: the overuse of screening and diagnostic tests.
It’s a problem in our healthcare system for a couple of reasons.
First, the majority of healthcare providers are paid based on volume. In other words, the more patients they see, the more tests they run, the more surgeries they perform, then the more they get paid. It doesn’t matter if the outcome is poor, because they still get paid. In fact, they make even more money when patients need further treatment to treat the complications.
Second, healthcare providers in this country order too many tests because they are afraid they will be sued. Unfortunately, studies have shown that doctors who perform the most diagnostic tests, such as MRIs and CT scans, are sued less frequently for malpractice. We call this “cover your a**” medicine.
Patients, too, must share some of the blame. Doctors admit to ordering tests because patients ask for or demand them, such as a CT scan for a headache.
Seeking high-value, cost-conscious care
I’m thankful several physician and consumer groups have responded to our need to not only control rising healthcare costs, but provide better, safer care.
I just read an article in a healthcare magazine that featured an interview with a physician representing the American College of Physicians (ACP).
Five years ago the ACP published a report highlighting the overuse of costly tests.
Unsustainable rising health care costs in the United States have made reducing costs while maintaining high-quality health care a national priority. The overuse of some screening and diagnostic tests is an important component of unnecessary health care costs. More judicious use of such tests will improve quality and reflect responsible awareness of costs. Efforts to control expenditures should focus not only on benefits, harms, and costs but on the value of diagnostic tests—meaning an assessment of whether a test provides health benefits that are worth its costs or harms.
In the last five years, the ACP has made strides in educating both care providers and patients about low-value and high-value care.
Low-value care includes screening and diagnostic tests where potential benefits do not clearly outweigh the harms, including cost. It also includes all the duplicate tests that are often done on hospitalized patients, even though the tests aren’t really necessary.
The ACP has been working with internal medicine residency programs across the country, so hopefully the next generation of doctors will have a less-is-more mindset.
Patient education has also been a priority, and the ACP contributes to one of my favorite healthcare consumer websites, Choosing Wisely. Choosing Wisely offers patients evidence-based information about many tests and procedures that are unnecessary or even harmful. I think it’s an excellent resource, and refer to it frequently.
I know these changes won’t happen quickly. Our healthcare system is a behemoth that moves oh-so-slowly.
But it encourages me when I read about physicians who are taking a stand against overtreatment and finding innovative ways to educate their peers and patients.
For more information about overscreening and overtreatment, and how to protect yourself, check out my previous posts, or look on my Resources page under Evidence-Based Health Care.
- Screening mammograms – Benefits vs. harms
- Be informed – PSA screening tests
- Overscreening for hepatitis C
- Atul Gawande – Overtreatment, “Overkill”
- Be informed – Shared decision-making
- Three questions to ask your physician
And here are some of my favorite books on the subject!