Rising Medical Costs

Posted on Feb 21, 2012 in News | 0 comments

Curbing the Rise in U.S. Medical Expenditures

 Print This Post

Healthcare costs in the United States have skyrocketed over the past 30 years—from $253 billion in 1980 to more than $2.6 trillion a year in 2010.[1] And the average employee has seen his health insurance premiums increased by 11.3% over the past 10 years.[2]

What’s behind these astronomical cost increases? Is it the cost of pharmaceuticals? Increases in the cost of equipment and hospital personnel? Well, according to a study just published in the Annals of Internal Medicine[3], a good chunk of the increased cost of healthcare over the past decade can be attributed to the overuse of some common screening and diagnostic tests.

The study reports the findings from a committee of internists convened by the American College of Physicians (ACP). The committee represented various specialties, practice environments, and geographic locations throughout the United States. Each member of the group was charged with identifying common medical tests that are unlikely to bring high value to the patient or treating the patient’s condition. A test or intervention was considered valuable if its health benefits could justify potential harms and costs, based on the principle that diagnostic tests should not be performed if the results will not change clinical management. As well, the committee was asked to consider the downstream costs and potential health risks incurred when tests in an asymptomatic patient result in a false-positive.

The committee identified 37 situations it believed do not represent high-value, cost-conscious care. Among them were

• Coronary angiography in patients with stable angina on medical therapy or who lack high-risk criteria on exercise testing
• Annual cholesterol screening for those who have normal levels and aren’t taking cholesterol-lowering drugs like statins
• Magnetic resonance imaging rather than mammography in women at low-to-average breast cancer risk
• Obtaining an electrocardiogram (EKG) to screen for heart disease in those who aren’t at high risk
• Exercise testing for patients with a low risk of heart disease and no chest pain while exercising
• Dual-energy x-ray absorptiometry screening for osteoporosis in women younger than 65 years without risk
• Repeat colonoscopy within 5 years in patients who have no signs of polyps
• Cervical cancer screening in low-risk women aged 65 or older and in women who have had a total hysterectomy for benign disease
• Blood tests for suspected early Lyme disease in those with vague symptoms
• Screening for colorectal cancer or prostate cancer in patients older than age 75 years
• Performing imaging studies, such as MRIs, in patients with nonspecific low back pain
• Ordering extensive blood panels in healthy patients undergoing elective surgery
• Brain imaging scans to evaluate recurrent classic migraines in a patient with a normal neurological exam

Data suggest that there is an abundance of unnecessary testing with some sources estimating that nearly 5%—or almost $700 billion—of the nation’s gross national product is spent on unnecessary tests and procedures that don’t improve patient outcomes.[4] As a physician, you have an ethical and professional responsibility to try and ensure that healthcare resources are spent wisely and responsibly. An accompanying editorial provided some questions you can ask yourself before you order a test (Table 1).[5]

Undoubtedly, many of you will take issue with some of the testing scenarios presented above. The journal invites you to complete a brief Internet survey to indicate how you feel about each of the measures or to add tests to the list.

 

 

Jill Shuman, MS, ELS
Published February 21, 2012

 

References

1. Centers for Medicare & Medicaid Services. National Health Care Expenditures Data, 2010. http://www.cms.gov/NationalHealthExpendData/02_NationalHealthAccountsHistorical.asp#TopOfPage. Updated January 11, 2012. Accessed February 6, 2012.
2. The Kaiser Family Foundation -and- Health Research & Educational Trust. Employer Health Benefits: 2011 Summary of Findings. http://ehbs.kff.org/pdf/8226.pdf. Accessed February 6, 2012.
3. Qaseem A, Alguire P, Dallas P, et al. Appropriate use of screening and diagnostic tests to foster high-value, cost-conscious care. Ann Intern Med. 2012;156(2):147-149.
4. Orszag PR. Increasing the value of federal spending on healthcare. Congressional Budget Office. July 16, 2008. http://www.cbo.gov/ftpdocs/95xx/doc9563/07-16-HealthReform.pdf. Accesssed February 6, 2012.
5. Laine C. High-value testing begins with a few simple questions. Ann Intern Med. 2012;156(2):162-163.