About half of Medicare beneficiaries who received diagnostic testing had the same procedure unnecessarily repeated within three years, increasing health care costs and reducing the amount of time providers have for new patients, according to a new study in the Archives of Internal Medicine.
The study analyzed a random sample of 5% of beneficiaries and examined the 50 largest metropolitan areas to determine their proportion of repeated tests. Researchers assessed the prevalence of six medical tests: chest CT scan, cystoscopy, echocardiography, lung function tests, stress tests, and upper endoscopy.
The data showed that within three years of the initial procedure:
- 55% had a second echocardiogram;
- 49% underwent a repeat pulmonary function test;
- 41% had repeat cystoscopies; and
- 35% had a second upper endoscopy.
Beneficiaries in Miami had the highest number of repeat testing, while those in Portland, Ore., underwent the fewest repeat tests.
Gilbert Welch, lead author with the Dartmouth Institute for Health Policy and Clinical Practice, said repeat testing is not a good medical decision unless patients present with new symptoms. The researchers noted that although the extra tests themselves do not necessarily carry an extra risk, repetitive testing increases the risk of overdiagnosis and unneeded treatment. However, the study noted that physician payment systems often provide financial incentives for doctors to recommend more frequent testing.
An editorial accompanying the study called the results "discouraging." The researchers recommended that physicians use electronic clinical guidance systems and that the industry discourage fee-for-service payment systems.
Rachel Werner, a health policy researcher at the University of Pennsylvania who was not involved in the study, said provisions in the Affordable Care Act will attempt to change fee-for-service systems to emphasize outcomes over quantity of procedures (Kutscher, Modern Healthcare, 11/19 [subscription required]; Pittman, Reuters, 11/19).
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Daily roundup: Nov. 20, 2012