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Unnecessary Medical Care Is More Common Than You Think

| February 1, 2018

Looking for savings can be challenging. (Michael Feddersen)

Looking for savings can be challenging. (Michael Feddersen, US Navy)

It’s one of the intractable financial boondoggles of the U.S. health care system: Lots and lots of patients get lots and lots of tests and procedures that they don’t need.

Women still get annual cervical cancer testing even when it’s recommended every three to five years for most women. Healthy patients are subjected to slates of unnecessary lab work before elective procedures. Doctors routinely order annual electrocardiograms and other heart tests for people who don’t need them.

That all adds up to a substantial expense that helps drive up the cost of care for all of us. Just how much, though, is seldom tallied. So, the Washington Health Alliance, a nonprofit dedicated to making care safer and more affordable, decided to find out.

The group scoured the insurance claims from 1.3 million patients in Washington state who received one of 47 tests or services that medical experts have flagged as overused or unnecessary. What they found should cause both doctors and their patients to rethink that next referral. In a single year:

  • More than 600,000 patients underwent a treatment they didn’t need, treatments that collectively cost an estimated $282 million.
  • More than a third of the money spent on the 47 tests or services went to unnecessary care.
  • Three of four annual cervical cancer screenings were performed on women who had adequate prior screenings — at a cost of $19 million. 
  • About 85 percent of the lab tests to prep healthy patients for low-risk surgery were unnecessary — squandering about $86 million.
  • Needless annual heart tests on low-risk patients consumed $40 million. 

Susie Dade, deputy director of the alliance and primary author of the report released Thursday, said almost half the care examined was wasteful. Much of it comprised the sort of low-cost, ubiquitous tests and treatments that don’t garner a second look. But “little things add up,” she said. “It’s easy for a single doctor and patient to say, ‘Why not do this test? What difference does it make?’”

ProPublica has spent the past year examining how the American health care system squanders money— often in ways that are overlooked by providers and patients alike. The waste is widespread — estimated at $765 billion a year by the National Academy of Medicine, about a fourth of all the money spent each year on health care.

The waste contributes to health care costs that have outpaced inflation for decades, making patients and employers desperate for relief. This week Amazon, Berkshire Hathaway and JPMorgan rattled the industry by pledging to create their own venture to lower their health care costs.

Wasted spending isn’t hard to find once researchers — and reporters — look for it. An analysis in Virginiaidentified $586 million in wasted spending in a single year. Minnesota looked at fewer treatmentsand found about $55 million in unnecessary spending. 

Dr. H. Gilbert Welch, a professor at The Dartmouth Institute who writes books about overuse, said the findings come back to “Economics 101.” The medical system is still dominated by a payment system that pays providers for doing tests and procedures. “Incentives matter,” Welch said. “As long as people are paid more to do more they will tend to do too much.”

Dade said the medical community’s pledge to “Do no harm” should also cover saddling patients with medical bills they can’t pay. “Doing things that are unnecessary and then sending patients big bills is financial harm,” she said. 

Officials from Washington’s hospital and medical associations didn’t quibble with the alliance’s findings, calling them an important step in reducing the money wasted by the medical system. But they said patients bear some responsibility for wasteful treatment. Patients often insist that a medical provider “do something,” like write a prescription or perform a test. That mindset has contributed to problems like the overuse of antibiotics — one of the items examined in the study.

And, the report may help change assumptions made by providers and patients that lead to unnecessary care, said Jennifer Graves, vice president for patient safety at the Washington State Hospital Association. Often a prescription or technology isn’t going to provide a simple cure, Graves said. “Watching and waiting” might be a better approach, she said.

To identify waste, the alliance study ran commercial insurance claims through a software tool called the Milliman MedInsight Health Waste Calculator. The services were provided during a one-year period starting in mid-2015. The claims were for tests and treatments identified as frequently overused by the U.S. Preventive Services Task Force and the American Board of Internal Medicine Foundation’s Choosing Wisely campaign. The tool categorized the services one of three ways: necessary, likely wasteful or wasteful. 

The report’s “call to action” said overuse must become a focus of “honest discussions” about the value of health care. It also said the system needs to transition from paying for the volume of services to paying for the value of what’s provided.

–Marshall Allen, ProPublica, co-published with NPR’s Shots blog.

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6 Responses for “Unnecessary Medical Care Is More Common Than You Think”

  1. Lou says:

    Health care providers got rent and payroll to meet.
    Each patient is a billable economic unit.
    It is up to you to manage your care and question the health care provider.

  2. Richard says:

    I agree with Lou, the health of each individual is manged by ones self. I don’t let anyone cut into me unless it’s absolutely necessary.

  3. Sherry says:

    Follow the Money! It’s very sad to say that you can no longer put blind trust in your doctor. Question your health care provider and get a second or even third opinion.

  4. MannyHMo says:

    A second opinion is a must if possible on serious cases,
    A horrible example is that of Dr. Farid Fata, cancer specialist who is serving 40 yrs. In prison for diagnosing and treating every patient of his as having cancer that is whether he has cancer or not !

  5. Stranger in a strange land says:

    I highly reccomend reading the articles I attached below if you want to understand why there are so many unnecessary procedures and why we spend so much on healthcare in the US and have outcomes that are much worse than in countries that spend a lot less (per person). If you are over 50 I highly reccomend trying (and working at it) physical therepy before surgery for orthopedic issues such as shoulder pain, back, knee, and hip pain. Staistics show for those over 50, Outcomes are about equal.

    Also, We have a amazing resource nearby in the Mayo Clinic that uses an outcome basis to measure their doctors as well as a value based method of determining care. If you have a serious diagnosis or are not getting a definitive diagnosis, go to the Mayo Clinic. Your own doctor may be very nice and you trust him, but I would rather have a doctor that knows more, is more experienced with my problem, and has the best equipment when dealing with a serious health issue. I have a friend coming to the Jacksonville Mayo Clinic from Texas because they are the best.

    Here are the articles:

  6. Pogo says:

    @Stranger in a strange land

    Many are called – too few ever Grok. How many of trump’s Earthlings do you honestly think will read your links?

    If you agree with your links – how do you like tricky ricky and his crew’s current brain fart?

    ‘Certificate Of Need’ Repeal Proposed In Senate

    By The News Service of Florida • Jan 4, 2018

    “…Under certificate-of-need laws, hospitals are required to get approval from the state Agency for Health Care Administration before they can build facilities or add new services. House Republican leaders and Gov. Rick Scott have long wanted to repeal the regulations but have been stymied in the Senate…”

    Full article

    I’ll throw in a little historical perspective to add to the excellent links to The New Yorker supplied by SIASL.

    A Bygone Era: When Bipartisanship Led To Health Care Transformation

    October 2, 2016

    John Henning Schumann

    “…Known formally as the Hospital Survey and Construction Act, Hill-Burton started as a Truman initiative. In November 1945, only two months after the official end of World War II, he gave a speech to Congress outlining five goals to improve the nation’s health. The first and least controversial of these called for constructing hospitals and clinics to serve a growing and rapidly demilitarizing population…”

    Full article

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