FRIDAY, May 19 (HealthDay News) -- Unnecessary medical tests ordered during routine physical exams are costing the U.S. health-care system millions, if not billions, of dollars each year, a new study contends.
And with those tests comes the gratuitous stress that such exams can cause patients, the researchers said.
"Tests are ordered that aren't recommended," said study lead author Dr. Dan Merenstein, assistant professor of family medicine at Georgetown University School of Medicine.
The findings weren't a surprise to experts in the field.
"Until the system provides financial incentives to reward the use of highly valued services and penalizes for those unproven interventions, the use of these unwarranted interventions will continue," said Dr. Mark Fendrick, professor of internal medicine and of health management and policy at the University of Michigan School of Medicine.
"These types of massive screening activities are not very cost-effective generally," added Greg Scandlen, founder of Consumers for Health Care Choices. "If a patient is in an at-risk group, then this kind of screening is appropriate, but the cost of doing it to large numbers of people just to find a tiny fraction of people with a problem is not justified," he added.
Routine preventive health exams, or regular physical exams, are designed to identify diseases in their early stages and prevent other diseases from occurring. While tests can be part of these doctor's visits, it's not often clear which ones are beneficial to generally healthy people coming for a check-up.
The authors of the new study, which appears in the June issue of the American Journal of Preventive Medicine, based their study on recommendations of the United States Preventive Services Task Force, a panel of experts that ranks different preventive screening measures.
Measures are graded "A," "B," "C" or "D." Tests in the "C" category are those for which the panel has made no recommendation for use. Tests in the "D" category are those which the panel has recommended against, because risks outweigh benefits.
The study focused on three tests in the "D" category: EKG or electrocardiogram, urinalysis and chest X-ray. The researchers analyzed data on 4,617 routine physicals involving adults aged 21 and over from a national survey conducted by the U.S. Centers for Disease Control and Prevention.
At least one of the three "D" interventions was ordered 43 percent to 46 percent of the time, the researchers said.
Using extrapolation techniques, Merenstein and his colleagues determined that direct medical costs for the three "D" tests ranged from $47 million to $194 million. Adding in two other tests from the "C" category pushed the costs up by another $12 million to $63 million.
Those numbers are, in all likelihood, an underestimate, Merenstein said. The authors estimated that if 20 percent of EKG results were false, the follow-up tests would cost yet another $683 million.
And these numbers don't take into account various indirect costs, including missed work days. Nor do they reflect the psychological effects on a patient, especially the stress of getting a false-positive result, the researchers said.
"It's not just economic," Merenstein said. "There can be unintended health risks, for example, radiation from a chest X-ray. And there's a lot of stress involved if you're told you have an abnormal EKG."
The study authors didn't look specifically at why these tests were overused, but Merenstein has some theories. "Doctors could do it to appease patients or because the physicians themselves think they're supposed to do them. And, if they owned a lab, some doctors did it for financial reasons," he said.
Experts said the answer to the problem lies in an overhaul of the nation's insurance system.
"The answer to this is value-based insurance design, which gives patients and clinicians financial incentives to do those highly valued services, and financial disincentives to minimize the use of those unwarranted services," said Fendrick, who's also co-editor-in-chief of the American Journal of Managed Care. Such programs are being tried out at the University of Michigan, he said.
Scandlen added: "This is precisely the thing that consumer-driven health care can address and that third-party payment never will. It's easy enough when you go to a doctor's office, and you can say, 'I don't care what it costs, let's do it.' At that point of transaction, both patient and physician have very little in the way of reason not to perform the tests. In a consumer-driven world, the patient has every reason to question where the test is necessary."
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