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The United States spends over $300 billion annually on unnecessary medical treatment, including diagnostic testing.
By: Andrea Wickstrom
In the United States, 4 to 5 billion medical tests are performed each year. According to one study, up to 60 percent of these tests may be unnecessary.
Excessive testing is only one part of what is considered low-value health care, a term that refers to health services that provide little or no benefit, cause potential harm, incur significant costs, or waste limited resources. This type of health care comes with plenty of risks—and little reward—for Americans.
Room for Error: The Effects of Excessive Testing
The study, published in The American Journal of Medicine, focused on unnecessary testing in the first 24 hours after hospital admission. While certain tests are necessary to help rule out any underlying causes, the study found that, upon physician review, over 31 percent of day-of hospital admission tests were needless and did not change the course of the patient’s care.
When patients have excessive diagnostic tests, the potential for errors exists. False positive or false negative test results can lead to a “diagnostic cascade” of more testing or unnecessary prescriptions and harmful side effects. This can interfere with proper treatment.
What Drives Overtesting?
Wasteful health care happens when tests are done without improving health outcomes or enhancing clinical decision-making. Overtesting is influenced by many factors, from the decisions of doctors and patients to the structure of the health care system itself.
A Lack of Knowledge
A research article in BMC Health Services Research determined that wasteful testing was due to compensation for a lack of knowledge and understanding. Primarily, these physicians reported wanting to reduce uncertainty and just be safe by performing a wide range of tests in hopes that an abnormal test result would explain the patient’s symptoms or illness. However, they also revealed that increased training and experience helped them make decisions.
Patient Concerns and an Inefficient System
Surveyed physicians showed the top three reasons health care providers—including physician assistants and nurse practitioners—report overtesting are fear of malpractice lawsuits, patient requests or demands, and the inability to access patient records quickly.
Dr. Ernie Vesta, a veteran emergency room and primary care physician, communicated with The Epoch Times via email. He said that providers should have supportive evidence that they evaluated and addressed the risks of testing beforehand. However, they want to use their authority to protect against accusations or neglect.
Dr. Vesta affirmed: “I don’t know one provider who practices without fear of litigation.”
Without diagnostic testing, patients, parents, and families may be left wondering if they were thoroughly evaluated. People are often encouraged to advocate for themselves in their medical care. Some may interpret this as asking for more tests.
With many health systems and private practices, it can be difficult to access health records quickly. It may be quicker to repeat a recent test than request records.
Time-constrained health care providers, facing these pressures and obstacles, may default to the path of least resistance and just order the tests.
Preoperative Testing
According to one systematic review, the most prevalent diagnostic tests were for uncomplicated low back pain and preoperative evaluations.
The Epoch Times interviewed Alex Morgan, a certified registered nurse anesthetist with a doctorate in nursing practice, who shared his experience and insight via email.
Mr. Morgan said that most current evidence-based guidelines are based on expert opinions. Preoperative labs or testing is not currently recommended for low-risk patients having low-risk surgery.
He stated: “Unfortunately, most institutions don’t practice this way.”
Protocols are created to ensure preoperative testing is done on patients who need it. Age, preexisting diseases, and the surgery type are considered. However, due to protocols, otherwise healthy people get unnecessary tests done.
Mr. Morgan pointed to one study that showed about half of low-risk surgeries performed at Veterans Affairs hospitals incurred over $11.5 million in charges from unnecessary preoperative testing.
Maximizing Profit: The Cost of Fee-for-Service Health Care
The United States health care system’s current structure rewards health care providers for providing more care, not necessarily the right care.
In a fee-for-service system, providers make more money if they order more tests. However, excessive spending costs everyone. Consequences of wasteful care are higher health care insurance premiums and out-of-pocket maximums. Patients may hesitate to follow through with recommended tests and treatments but do not want to be labeled noncompliant.
Imaging tests, such as X-rays, CT scans, and MRIs, can cost hundreds to thousands of dollars and may not be covered by insurance. However, it benefits the organization’s revenue.
Dr. Vesta noted that “spending is necessary when patients have chronic conditions to manage and require adjustments to their care plans.” He added: “The end of my pen is where all spending starts.”
Searching for Solutions
Evidence-based practice interventions have been shown to reduce the number of unnecessary medical procedures and health care costs while not affecting patient satisfaction.
The American College of Physicians (ACP) “High Value Care” initiative states that it aims to improve health, avoid harm, and eliminate wasteful practices. Multiple physician societies endorse this initiative, which includes increased awareness of appropriateness in testing and treatment, educational strategies, and changing test order forms.
Health care providers are considered gatekeepers and stewards for patients accessing health care and diagnostic testing. Diligence is key in limiting overtesting and preventing the diagnostic cascade that can follow.
The ordering health care provider’s ethics are not in question; they want what is best for their patients and don’t want them to slip through the cracks.
The American Board of Internal Medicine’s Choosing Wisely campaign recommends patients ask their physicians some simple questions before undergoing any test or treatment, including the following:
Do I really need this test or procedure?
What are the risks and side effects?
Are there simpler, safer options?
How much does it cost, and will my insurance pay for it?
Finally, possibly the most overlooked question is: What happens if I don’t do anything?
