In the United States, 4 billion to 5 billion medical tests are performed each year. According to one study, up to 60 percent of those 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.
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, more than 31 percent of day-of-hospital-admission tests were needless and didn’t change the course of the patient’s care.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 done to compensate 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 better decisions.Patient Concerns and an Inefficient System
Surveyed physicians showed the top three reasons why health care providers—including physician assistants and nurse practitioners—resort to 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, told The Epoch Times via email that providers should have supportive evidence that they have evaluated and addressed the risks of testing beforehand. However, they want to use their authority to protect against accusations or neglect.
“I don’t know one provider who practices without fear of litigation,” he said.
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 that 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 to request records.
Preoperative Testing
According to one systematic review, the most prevalent diagnostic tests were for uncomplicated low back pain and preoperative evaluations.Alex Morgan, a certified registered nurse anesthetist with a doctorate in nursing practice, said most current evidence-based guidelines are based on expert opinions. Preoperative labs or testing isn’t currently recommended for low-risk patients having low-risk surgery.
“Unfortunately, most institutions don’t practice this way,” he told The Epoch Times via email.
Protocols are created to ensure that 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.
Maximizing Profit: The Cost of Fee-for-Service Health Care
The United States health care system’s current structure rewards providers for supplying more care, although 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. The 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 don’t 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.”
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.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.
- 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?
Copy
