Health Care Spending On Unnecessary Tests Discouraged By Major Medical Groups

WASHINGTON -- With health care costs growing out of control, medical societies made up of family physicians, cardiologists and other specialists have a message for America's doctors: Don't be so quick to order expensive procedures like CT scans and X-rays. Unnecessary tests and treatments pad the nation's health care bill and expose patients to needless risks, the groups say.

On Wednesday, nine doctors' organizations -- including the American College of Physicians, the American Academy of Family Physicians and the American College of Cardiology -- along with business and consumer groups are launching an effort to reduce unnecessary medical tests and treatments, thereby saving costs and cutting back on patients' exposure to stressful and sometimes dangerous procedures.

The "Choosing Wisely" campaign is the latest push by groups representing American doctors to rein in wasteful spending that arises out of physicians' assessments of what constitutes best practices for patients. The nine doctors' groups emphasize that patients don't always need high-tech testing, at least not as a first resort.

Waste in the U.S. health care system is estimated to be as high as $850 billion a year, according to a 2009 Thomson Reuters report. For example, 44 percent of people between ages 40 and 60 told Consumer Reports in 2010 that they had received heart-disease screenings like electrocardiograms or "stress tests" despite having no symptoms and not being considered at risk for heart disease.

The American Board of Internal Medicine Foundation organized the campaign, which is also supported by the Service Employees International Union, the National Partnership for Women & Families, AARP, Wikipedia, Consumer Reports, and the National Business Group on Health and other organizations representing employers that provide health benefits to their workers.

The organizations identify 45 tests or procedures about which doctors and patients should think twice. "Physicians, working together with patients, can help ensure the right care is delivered at the right time for the right patients," said Christine Cassel, president and CEO of the American Board of Internal Medicine Foundation, in a news release.

Electronic tests like MRIs for lower-back pain, routine CT scans of the brain and chest X-rays, and cardiac stress tests for patients with no symptoms should be avoided unless the physician and patient determine there's a specific reason for the procedure, according to the guidelines. The groups also advise against routinely prescribing antibiotics for sinus infections, giving high doses of drugs to treat heartburn and other gastrointestinal disorders, and ordering Pap smears for women who are younger than 21 years old or have had a hysterectomy.

The American College of Physicians triggered a minor controversy earlier this year when it unveiled its own, separate set of guidelines. The organization named 37 tests that are overused and encouraged doctors to avoid them for patients without specific symptoms or risks of disease. Critics charged that the organization was encouraging the rationing of medical services because the American College of Physicians described its approach as "parsimonious care."

Comments

[crsnbarb]

09:23 AM on 04/05/2012

As a health care professional, I must say that I have seen abuses by physicians. Numerous people in their 90's with no history of heart disease or diabetes on statins, that will not help them in any way. I know of one chiropractor who sees post bunionectomy patients once a year for life for no valid reason. This is, of course, not the majority of physicians who are conscientious and honest. I recently had an optometrist recommend an expensive test to be done semi-annually. When I asked what intervention was available if it showed progression of my condition, he said "Nothing, but what do you care? Medicare pays for it." I changed optometrists.

[tlcpro]

07:42 AM on 04/05/2012

What I don't like is that all of the people reading these tests are not employed by the hospital that gives them. You get a separate bill. I recently had an ultra sound done and got a bill from the tech that read the ultra sound. The test cost $894 and the reading of the test cost another $452. What is up with that? Then the doctor that ordered the test failed to tell me all of the results and sent me to a specialist. I'm glad for the specialist, because I know know the whole truth. What happened to hospitals employing these people directly rather than sub contracting this stuff out?

[prk1959]

08:10 AM on 04/05/2012

Radiologists (M.D. or D.O.) read ultrasounds, plain films, CT, MRI, mamms, vascular ultrasounds, nuclear scans. Radiologic technologists do not, we take the films or scans.

[Jarrod Putnam]

07:15 AM on 04/05/2012

We need to worry about waste not just in the healthcare system, but our society as a whole.

[Kvetguy]

11:20 AM on 04/08/2012

Then let's start somewhere..
It is like Enerfy we talk talk and tlak but do little and complian 50 years later

[Jarrod Putnam]

11:44 AM on 04/08/2012

Agreed. Sadly most of the people who have the power to begin the process seem to care very little about any of the problems.

[rtx47]

11:51 PM on 04/04/2012

A quick was to solve the problem of unnecessary tests and treatments is to stop payimg for them.

And giving the patient the right to seek pay-back that the patient can split with their insurance carrier or Medicare or Medicaid.

Any remedy short of such financial action and penalty to the providers (doctors and hospitals) is spin, empty rhetoric, waste of time and destined to failure.

[JustMyWords]

01:54 PM on 04/05/2012

Personally, the last person I want to have deciding whether or not my medical test/treatment is necessary is a bean-counter employed by a for-profit health insurance company, thank you.

It's one thing for a medical organization to make recommendations regarding testing. It's something else entirely to allow someone who stands to benefit financially by denying that test to be in a position to decide whether or not to pay for it. Especially if they're making that decision AFTER the fact.

[Kvetguy]

11:29 AM on 04/08/2012

Just thinking like that make the system corrupted
at least the organization offers an analysis that we cann use and adapt to take action

There is too much tests done in the US health care system compared to all other systems in the world but basically we in the US have decided it is better to pay and get the worst quality anyway
and even better, we will pay for the non-insured because we are unable as a nation to decide how to fund the monster

I think they should also stopped the car insurance system...

[Jerome Bigge]

11:37 PM on 04/04/2012

Have had this happen myself. Had a gastroenterolist's physician assist pressure me into having an x-ray bone scan to see if my bones were thining due to age. Told her that my Medicare Advantage insurance wouldn't cover. She checked, found it wouldn't. So she called my primary care physician and had him write a prescription for the bone scan. Waste of money of course! I see this sort of stuff all the time. Unnecessary tests, unnecessary office visits, "up coding", all stuff that doctors do all the time to put more money in their pockets. No wonder US health care costs are so high when all of this stuff goes on every day!

[medicontheedge]

10:11 PM on 04/04/2012

I work in an emergency dept, and can tell you that the waste and needless ordering of expensive tests is stunning!
I call it the "you want fries with that?" and cookbook medicine. Pathways developed to standardize and make more efficient treatments have ballooned the number of useless, expensive, and unnecessary tests just cause they are automatically ordered. An ECG on an otherwise healthy 16 year old girl with an infected toe???? Well, it is in the septic panel!
That being said, I do get a paycheck from all of it!

[Jerome Bigge]

11:40 PM on 04/04/2012

Called "spreading the money around". It wouldn't surprise me to learn that doctors are "told" to do this sort of stuff so that more money can be brought in, enough so everyone gets a good paycheck. This is also why Americans pay twice as much for their health care as do the people fortunate enough to live in a developed country where the government exists for the benefit of the people, not for the wealthy 1% types as is the case here in the United Corporate States...

[Suzanne English Walker]

05:52 PM on 04/04/2012

If it wasn't for testing, my husband would now be deceased. Lung cancer is usually deadly, but because our doctor was diligent, his lung cancer was detected early and removed. That was almost four years ago. Thank God for early detection.

[General Washington]

09:22 PM on 04/04/2012

That's a good story to hear, but one has to ask: Was his history that of someone at a heightened risk for lung cancer that necessitated those tests being done?

Was he a smoker? Did he work in the coal or construction industry? Did he have a history of exposure to airborne chemicals in the petrochemical industry?

The problem is ordering tests that have no basis in need other than for financial (physician kick-backs) rather than medical reasons.

[olitenup]

05:32 PM on 04/04/2012

But vaginal probes are AOK?

[Jerome Bigge]

11:43 PM on 04/04/2012

Republicans greatly regret that women have the vote. I suspect they fought woman sufferage back in the early part of the 20th Century just for this reason. You will note that Republicans are now doing everything they can to keep people likely to vote Democratic from voting. They have good reason to be doing this considering their behavior over the last few years.

[mansterEZ]

04:13 PM on 04/04/2012

This is exactly why we need medical records on a flash drive and/or digitized so where ever we go a medical professional can have direct access to treat an imminent condition.

[John Eppstein]

04:04 PM on 04/04/2012

Great - just what we need - even worse health care than we already have now. Thinking like this almost killed me when I developed CHF and the doctors insisted on treating it like an easily treated respiratory disease - without even checking my heart.

What we need is single payer "socialized" medicine with standardized fees for tests and without the intervention of money grubbing HMOs and insurance companies. THAT would decrease the cost of health care. But the Republicans won't permit that to happen.

[babue]

03:42 PM on 04/04/2012

mine is a question: why are these tests sooo expensive? with so many people getting them, you would think they could be given less expensively. like how much were the same tests 10 years ago. i have read that doctor owned machines tend to be more expensive.

[cubs835]

03:55 PM on 04/04/2012

money driven medicine - plain and simple - everyone including doctors (of which I'm one) are businesses (small and large, private and corporate) - all of us what to make money off your healthcare and at nearly every step from the ambulance to the therapist, to the crutch maker, the test machine seller, the test machine user, etc, etc ,etc - are trying to make the best buck they can at each and every step of the process

[mansterEZ]

04:19 PM on 04/04/2012

IMHO anyone whose business model intends to profit from the pain, suffering, and misery of others is a blatant unrepentant sociopath. I'm not including reasonable compensation for those who actually provide the care. We need a universal healthcare system that delivers the needs of patients and doctors/medical professionals, leaving out 3rd party intervention like insurance companies etc.

[hellothereandhere]

11:03 PM on 04/14/2012

Then how do you mentally feel about that ?

[Jerome Bigge]

11:50 PM on 04/04/2012

More money in the doctor's pocket. I suspect that during their medical training, they are taught to view their future patients as "money machines" to be exploited for their own benefit. They have the viewpoint of an aristocrat who is dealing with some ignorant peon at times. I've had three times in my life where medical errors were made because some doctor was too much in a hurry to actually seriously check things out. This is why I have a low opinion of the profession. I think the government has given far too much power in the form of prescription laws, laws that they use mainly to enrich themselves at the expense of their patients. The last time, after wasting well over a thousand dollars in tests, both with a specialist and a primary care physician, I went on the Internet and found out what was wrong in less than ten minutes. Turned out the problem was due to a side effect of one the medications I was on. Both doctors knew what meds I was on, but neither bothered to actually look up the side effects of one of the meds they'd put me on!

[nascent]

03:37 PM on 04/04/2012

The health care academics who want to do away with all the testing are dreaming. As long as an attorney can stand in front of a jury and say that "The doctor should have run this (dramatic pause) life saving test, but refused to in order to save a few bucks", then every test that can be run will be run.

My wife works with a woman who daughter just gave birth to her first granddaughter. The child had a small hairline skull fracture; it developed in the uterus, was diagnosed prior to delivery, and is a not uncommon problem with an otherwise normal childbirth. My wife's friend acted like they had won the damn lottery; she's drooling in anticipation of the oodles of money they expect to get for this episode of non-malpractice.

It likely will never come to pass - even our malpractice system is not yet corrupt enough to indict for normal events. But her attitude is shared by many Americans, some of whom look forward to getting sick so that they can get a chance at the big lottery drawing called malpractice. It drives up costs, drives down quality, complicates life for the health system, including patients, and apparently is what liberal America wants.

There is truth to the notion that our malpractice system holds the worst doctors accountable, but there are better ways to do it, and we can't afford the current way (unless, of course, we happen to be a lawyer...)

[kkurtt]

07:44 PM on 04/04/2012

The article didn't say get rid of all testing. I think you slid down the "slippery slope" prematurely.

[jocko295]

02:57 PM on 04/04/2012

Don't nany of the Doctors ordering these procedures have business interest in these imaging companies?

[mansterEZ]

04:24 PM on 04/04/2012

A really good point. It's called conflict of interest and is exactly what our elected officials ([sic] leaders) are intimately engaged. Our entire economy is built upon follow the leader. Nothing can change until we citizens insist our elected representatives stop caving to special interests. :)

{{{your first FAN}}}

[legge001]

05:01 PM on 04/04/2012

The Stark Law prohibits this which is not to say there is not less obvious indirect mutual back scratching going on in some settings.

[Neets101]

02:43 PM on 04/04/2012

There are a number of factors that influence decisions to test or not to test, one of them obviously is the practice of "defensive medicine" for the physician to cover his butt, the practice of "I just bought this new machine and the first payment is due in four weeks" medicine.

The incentive in the way medicine is practiced in the U.S. is more treatments = more profits, not good patient outcomes = bonus the way it is practiced in the rest of the first world.

There will now be additional pressures on physicians to not order tests - from this association.

Damned if they do, damned if they don't, halo hanging from horns, our opinions of physicians from positive to negative have morphed into a matter of what is currently in fashion.

When you look at many of these factors, the only attractive factor to practicing medicine in the U.S would be the money, given the rest of it all that comes with it, yikes.

So the system in its' present form is in itself encouraging the evolution of the practice for the love of money and nothing more, thankfully it is not all that way as of yet, there are many honorable people in the profession of healthcare, how long it takes them to burn out is another reason to make as much moolah as fast as you can, so you can retire, even for those with the best of intentions it's a lot of pressure...

[Elsa Weber]

01:51 PM on 04/04/2012

Our Medical system is so complicated that there are no simple solutions to making it better. Telling doctors that they are testing too much only works for a little while until they discover ways around any new rules that have been set. Letting the for-profit insurer tell doctors what to do only ends up with people not getting the treatment they need and no preventive care or education. Big pharma has turned this nation into one which looks to pills and other artificial means of staying healthy. They advertise their pill on TV, offer free samples, and sit on every single group that is trying to establish proper treatment guidelines. Doctors go to school for many years, they are required to have continued education, do we really need large corporations that make drugs, medical equipment and devices providing that education? The whole system is way too complicated and is making a few very rich and yet failing through increasing medical mistakes and misdiagnoses that leads to injury and death of far to many people. Not to mention the 60 million Americans that have no access to health care except through Emergency Rooms. This is just one more campaign that will not fix the problem.