In an article By: LAURAN NEERGAARD, AP entitled, "Doctor groups issue list of overused tests, therapies", the reader is encouraged to question the physician about why the test needs to be performed. Sometimes the tests are actually harmful to the consumer and are costly especially for the patients who do not have insurance, adequate coverage or high deductibles. The downside is that the physician may not see reimbursement for their services because the patients cannot pay. A lot of times it is written off as bad debt...and that is a huge loss of income to the physician if this happens on a regular basis.
Some of the tests that my research found unnecessary are:
1. EKG for low-risk people. According to Consumer Reports, 44% of patients without presenting symptoms were given EKGs, exercise stress tests, or ultrasounds. The problem is that it can show a false positive leading to cost prohibitive procedures that are totally unnecessary, like angioplasty, stents and other procedures!
2. Bone Scans for women under 65 or men under 70. Some doctors are testing women as young as 50. Unless they are at high risk because of smoking or using steroids, women at this age are not at risk.
3. Allergy tests. "Some doctors are performing immunoglobulin (IgG), for food allergies. But Linda Cox, M.D., president elect of the allergy group, says the test simply doesn't work.
For seasonal allergies, many doctors run a battery of blood and skin tests dubbed IgE, when just a few specific tests would do. By asking patients when and where they have symptoms, doctors can pinpoint what tests they should run."
The research goes on to show a number of other areas of unnecessary testing and procedures. Some of them are simply common sense approaches. Sometimes in the rush to be efficient and streamlined in healthcare, we are over-treating and getting paid less for our enthusiasm.
For example, Allow nature to take its course when a baby is supposedly due. Getting in a hurry to deliver the baby may lead to a C-Section which could have been avoided with a little patience. The end result of impatience is:
- It costs the insurance companies more money for an avoidable procedure.
- Patients are paying higher out-of-pocket expenses.
- The mother has a higher risk of infection and complications due to a surgical incision.
- The hospital stay and recovery time for the mother will be increased.
- The mother may have to be off work longer than she expected for additional recovery time. This costs somebody a lot of money!
So, why are doctors doing the unnecessary tests and procedures?
- Bottom line is that they do not was sued. Nobody has ever been sued for ordering too many tests. In today's society, there are people who take advantage of the smallest error and sue the physician. This drives up their medical malpractice insurance rates and he or she does not want the hassles of even a potential problem.
- Patient expectations. Some patients are demanding of more tests if they are not satisfied with the results of the first tests. Patients expect the doctor to fix the problem without having to change their lifestyle to take care of their own problem.
- Patients believe that more care is better. Contrary to popular opinion, a person could easily be over-medicated and exposed unnecessarily to harmful chemicals if they are tested too often. The side effects may outweigh the benefits of the tests.
- Drug companies incentives. It is easier to explain to a patient what the drug company thinks is best for them instead of taking the time to sit down and explain the risks and side effects.
- Financial Incentives. If a doctor invests in a machine, he is more likely to use it to recoup some of his expenses in its operation. They want to make sure before the issue a diagnosis because of potential lawsuits.
The decisions of a doctor also affect their staff. If they are ordering tests that are not fully covered by the patient's insurance, or if the patient is a self-pay, then payments have to be arranged and bills submitted to the patient every month.
Not to mention the fact that every test has to be documented as a medical necessity in order for payment to be made by Medicare and commercial insurance companies.
In the end, there is potential for non-payment and collections hassles and more write-offs leading to a loss of income.
The research suggests that before ordering tests and procedures, the doctor and patient together decide:
- Is it necessary?
- Is it affordable?
- Are the side effects worth the risk?
- Are there other less expensive alternatives to the procedure?
Together, you can make positive choices for your patients and your practice.
Resources Online:
1. http://www.choosingwisely.org Copyright 2013 The Associated Press. All rights reserved.
2.AARP Home 7 Medical Tests and Treatments You May Not Really Need Think twice before getting these procedures or meds
by: Elizabeth Agnvall, from: AARP Bulletin, April 4, 2012
3.Patient Safety , Public Health Medical organizations release list of 90 tests and procedures that often are not needed By Liz Kowalczyk, Globe Staff
4.http://articles.washingtonpost.com/2011-10-31/national/35276722_1_primary-care-medical-costs-internal-medicine-foundation/2
5.June 2012 issue of Consumer Reports magazine with the headline "When to Say ‘Whoa!’ to Your Doctor."
