Beware of Repeat Medical Tests

November 28, 2012

medical_monitoring.jpgOur Chicago medical malpractice lawyers are warning of unnecessary repeat medical testing that is happening in alarming proportions.

A new study by the Dartmouth Institute for Health Policy and Clinical Practice published in the Archives of Internal Medicine reports that doctors often perform unnecessary tests on Medicare beneficiaries. This can pose a severe threat to patients, as it may lead to incidental detection, over-diagnosis, and unnecessary treatment. Repeat tests are also restricting doctors' ability to treat new patients and adding to the nation's already burgeoning health care bill.

The research analyzed the proportion of repeat tests in 50 of the largest metropolitan areas. It looked at six types of tests: echocardiography, stress tests, lung function tests, chest CT scan, cystoscopy, and upper endoscopy for a random sample of 5% of older people with Medicare coverage.

The study made a startling discovery: within three years of the initial test or procedure, 55% of the Medicare beneficiaries had a second echocardiogram, 49% underwent a repeat pulmonary function test, 41% had repeat cystoscopies, and 35% had a second upper endoscopy. This meant that one-third to one-half of the six tests is done again within a three-year period.

An article in the Huffington Post revealed that cancer screening is grossly overused in the U.S. The report says that nearly 40 percent of Medicare expenditure on common preventive screenings is medically unnecessary. While repeat tests are justified if a patient continually develops new health issues, the magnitude of the repeat testing that is assuming epidemic proportions in the U.S. begs for proper evaluation and remedy.

One of the reasons for unnecessary tests and care could be the commonly held belief that more care is always better than less. Doctors may prescribe unnecessary tests to avoid facing a medical malpractice lawsuit - what is known as 'defensive medicine'. Doctors who practice defensive medicine drive up costs and affect the quality of care. Worse is the effect on the elderly patient due to the agony and potential morbidity from the unnecessary repeat tests.

Another obvious explanation for repeat tests is the excessive profit motive among physicians. Under the Medicare fee-for-service system, doctors and hospitals are reimbursed for every visit, test or procedure that is performed. Diagnostic tests cost from $200 to over $1,000. Prescribing unnecessary repeat tests seems to be the simple way to make more money. It has also been found that doctors who invest in expensive imaging machines for CT scans and MRI tests repeat more of these tests than those who have not bought such equipment. Patients should be especially wary of repeat X-rays and CT scans. These procedures involve exposure to potentially cancer-causing radiation.

The Affordable Care Act seeks to remedy the tendency for repeat test prescriptions by introducing value-based reimbursement in place of the fee-for-service system. The focus will be on patient outcomes rather the number of procedures performed. The aim is to eliminate procedures and tests that are medically unnecessary or only minimally necessary.

While there are many physicians who diligently go by the Hippocratic Oath, there are others who may not be so ethical. Patients with Medicare and their caretakers need to be cautious about repeat medical tests. Our Illinois medical malpractice attorneys advise patients to question their physicians about any repeat tests that they may recommend. Concerned physician groups have listed 45 overused tests and procedures. Being aware of these can help.

Curbing unnecessary medical tests is in the interests of the nation at large. According to the Congressional Budget Office, 30% of the nation's health care expenditures are on tests, procedures, doctor visits, hospital stays and other services that do not contribute to patients' health.