November 6, 2011


$6.9 Billion Spent Yearly On 12 Unnecessary Tests And Treatments (KaiserHealth, 11/01/11)

Minal Kale, an internist at Mount Sinai School of Medicine and lead author of the study, says $6.8 billion was a conservative estimate of the cost of the inappropriate care. She notes, for example, that the study didn't evaluate the cost of additional testing or procedures that result from an abnormal blood test reading result or imaging scan, even though in the absence of symptoms or risk factors the follow-up may be unnecessary and even cause harm. "The financial and other emotional results of that can be significant," she says.

The original list of primary care activities upon which Kale and her colleagues based their financial analysis was developed by the Good Stewardship Working Group under a grant from the American Board of Internal Medicine Foundation and published first online in May. Working group members were composed of internists, family physicians and pediatricians who are part of the National Physicians Alliance, a group of 22,000 doctors that advocates universal, affordable health care.

The working group focused on common activities that no physician would argue against, says Stephen Smith, a family physician and professor emeritus at Brown University's Alpert Medical School, who co-authored that group's paper. That's why you don't see more controversial practices like the PSA blood test for prostate cancer, which was recently removed from the U.S. Preventive Services Task Force's list of recommended screenings for most men. "What we were trying to do was change [physicians'] mindset, not cause firestorms of controversy," says Smith.

So why would physicians continue to order tests and prescribe pricey drugs when there's clear evidence that they're not necessary in many cases and may even cause harm by exposing people to unneeded care?

One of the main reasons is the way doctors are trained, Smith says. "I think all of us practicing in the U.S. were raised in an educational environment where we got dinged if we didn't order certain tests," he says.

Defensive medicine also plays a role. "Nobody ever gets sued for ordering unnecessary tests," says Doug Campos-Outcalt, a family physician in Phoenix and a past president of the Arizona Academy of Family Physicians.

And patient expectations drive some of the spending as well, say physicians, who note that sometimes simple directives, such as drinking less alcohol or getting more exercise, aren't what patients want to hear. "If a doctor says, 'Let's talk about weight control,' patients aren't usually too happy," says Campos-Outcalt. "They feel like there should be some testing."

Posted by at November 6, 2011 7:55 AM

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