February 1, 20185:01 AM ET
MARSHALL ALLEN
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 substantial expense that drives 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.
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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 the group 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.
§ 3 in 4
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 Chase 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 Virginia identified $586 million in
wasted spending in a single year. Minnesota looked at fewer treatments and 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.
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.
ProPublica is a nonprofit newsroom based in New York. You can
follow Marshall Allen on Twitter:@marshall_allen.
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