Unnecessary tests = unnecessary expense
This is a follow up to my last post about the dangers of too much medical care.
One of the biggest doors leading to an overabundance of healthcare and healthcare costs is the annual exam and all the “routine” lab work that is ordered almost without thought.
Doctors’ offices strive to be efficient. They have a lot of patients to see every day, after all.
One way they streamline their practices is to set up routine or “standing” orders for common lab tests, such as an electrocardiogram (EKG), complete blood count (CBC), urinalysis (UA), prostate screening antigen (PSA), lipid profile (cholesterol), vitamin D level, thyroid function (TSH), or a chemistry panel looking at liver and kidney functions.
Depending on age and gender, you get plugged into a specific template of routine tests. Electronic health records have made this extremely easy. Too easy, maybe.
Do your symptoms or risk factors really warrant all these tests? Or is it just easier and more profitable for your provider to order routine labs on everyone, regardless?
I think mostly the latter.
Fortunately, many healthcare consumer groups and physicians have been speaking up against annual exams and routine labs because there is no good evidence that they are beneficial, and they are costing us billions of healthcare dollars every year.
The U.S. health care system spends $300 million a year on unnecessary tests that are ordered in annual physicals. Billions more are spent on follow-up tests and treatments.
Related post: Do you need an annual exam?
Take charge of your healthcare
The best thing you can do is be informed. If you’re going to buy these tests, and want good value for your money, you need to understand what you are getting.
Ask your doctor these questions:
- What tests are being ordered? Why? (Don’t let your doctor get away with the old line “Because this is what we always do.” That just doesn’t work anymore!)
- Which lab tests are best for my personal risk factors, such as age, gender, family history, etc.?
- How will the results of these tests advance my personal healthcare goals?
- What will the tests cost? Are they covered by my insurance?
Not all routine labs are without value. But that doesn’t mean they need to be done every year on every patient.
As one physician writing on this topic put it,
…ultimately, we’ve got to use our brains. We’ve got to learn to think about doing what’s right, what’s best for each patient….we need to continuously remind ourselves that we don’t need to get labs, just because we own a lab, just because the patient has blood, just because we have tourniquets lying around and 28 gauge needles that need to be stuck somewhere.
A further word of warning based on my own experience: When you get to the lab, ask the person taking your blood to read the lab order and tell you what tests are being performed.
On more than one occasion I’ve specifically asked my doctor not to do a test, but the blood was drawn anyway. It never hurts to double check. The doctor or nurse can easily forget to remove a test from those darn “standing orders” and the burden will be on you to catch their mistake.
Read your Explanation of Benefits carefully!
After your doctor visit, your insurance company will send you an EOB or Explanation of Benefits. This tells you what your doctor office charged to the insurance company and how much was paid. It also tells you the balance you owe your care provider.
Read the EOB carefully and make sure you know what every charge is for. Depending on how your insurance company has designed its EOB, the charge may have just a code by it with no further explanation. I think they do this on purpose to make us more confused and less likely to challenge a charge.
Don’t pay the balance until you are satisfied you know what each charge is for, and that you actually agreed to each lab test. You will probably need to contact both the insurance company and your provider for more information. But it might be worth it. Some lab tests are well over $100!
If you find you were charged incorrectly, contact your doctor’s office and explain the problem.
On the instances where tests were done that I did not consent to, my doctor wrote off those charges. I felt bad for her, but really it was her responsibility to make sure the lab order was correct, wasn’t it?
Probably. But it’s still my responsibility as a consumer to know what I am buying and make sure I get what I am paying for, and not paying for something I neither want nor need.
Check out my Resources page for links to some good evidence-based medicine websites!