Medicare patients often receive repeated tests for which repetition is not routine, according to researchers who are worried that automatic or needless repeated tests not only sap finances from an already hard-pressed healthcare economy, but sometimes lead to adverse effects. Moreover, repetitive screening often finds abnormalities of no consequence but requiring yet further follow-up (over-diagnosis).
Gilbert Welch, M.D., from the Dartmouth Institute for Health Policy and Clinical Practice at Dartmouth College, and colleagues from the Medicare Payment Advisory Commission, analyzed data on 743,478 patients and six medical tests: echocardiography, imaging stress tests, pulmonary function tests, chest computed tomography, cystoscopy and upper endoscopy. Between one-third and one-half of the patients studied had the tests repeated within three years, for no apparent clinical reason, according to the study in Archives of Internal Medicine.
Echocardiography was the test most commonly repeated, despite specific recommendations by a cardiology task force against routine surveillance echocardiography. In an accompanying editorial, Jerome Kassirer, M.D., and Arnold Milstein, M.D., MPH, suggest perverse financial incentives as the reasons for the unjustified repeat testing.
After decades of attention to unsustainable growth in health spending and its degradation of worker wages, employer economic vitality, state education funding, and fiscal integrity, it is discouraging to contemplate fresh evidence by Welch et al of our failure to curb waste of healthcare resources, they wrote.
But hang on a second, says ACSH s Dr. Gilbert Ross, a former practicing internist who says he can see clinical reasons for doing repeat tests on some patients, especially older ones, which may have escaped detection by the researchers. For instance, when deciding whether to get a follow-up echocardiogram, the doctor considers that it s a completely safe and noninvasive test, so neither doctor nor patient has to worry about side effects. And getting specific information about cardiac status more often than every three years is far from outrageous.
I d like to see a more in-depth analysis of why these tests are repeated, agrees ACSH s Dr. Ruth Kava. There may be valid medical reasons for at least some of the repetition.
But ACSH s Dr. Josh Bloom says he has no trouble believing the Medicare reimbursement system is getting abused by unscrupulous practitioners. This is Freakonomics, basically, he says. You set up a system with certain incentives, and people adapt to those incentives.
