Low-value services snowball, adding to patients' bills

A new study published in the Journal of the American Medical Association finds that patients who receive certain kinds of testing may bew more likely to receive additional–and possibly unnecessary–health care services.

Per the JAMA study, low-risk patients who received either a chest radiograph, an electrocardiogram, or a Papanicolaou test within a certain period of time after their annual health exam were more likely to schedule follow-ups with specialists, diagnostic tests and procedures.

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Doing these tests — which are considered to be of low value by Choosing Wisely Canada, a campaign against unnecessary testing — could potentially harm a patient both physically and financially, the JAMA study found. For instance, the study cited other research showing that the cost of these additional tests was $565 per patient.

“False-positive screening test results can lead to more invasive procedures, such as bronchoscopy, cardiac catheterization, or colposcopy. Rarely, low-value screening tests may lead to major surgery, with the potential for life-limiting complications,” wrote the study’s authors, a group of American and Canadian physicians. “Therefore, in discussing the risks and benefits of screening tests with low-risk patients, physicians should help patients weigh the potential for harm against uncertain benefit.”

Groups like Choosing Wisely focus on the potential health side effects of unnecessary as opposed to the financial effects, and this particular study shows how frequently patients follow-up with additional testing, wrote Timothy Anderson and Grace Lin, doctors at the Beth Israel Deaconness Medical Center and the University of California, respectively, as part of an invited commentary.

“Efforts to reduce low-value testing through emphasis solely on cost savings are unlikely to be prioritized by fee-for-service health systems or physicians who may stand to lose revenue or by patients who may perceive these efforts as rationing,” Anderson and Lin wrote. “Research accurately characterizing the potential downstream benefits and harms of testing is an important avenue to reframe efforts to reduce low-value testing in a patient-centered manner.”

The JAMA study pulled data from administrative health databases in Ontario, Canada; researchers selected patients who had an annual health exam between 2012 and 2016. It comes amidst other research showing that low-value care costs the U.S. health care system between $75.7 billion and $101.2 billion a year.

Both the JAMA study and the commentary noted, however, that they could only assume that the three tests — the chest radiograph, electrocardiogram, and Papanicolaou test — taken during an annual exam were done for screening purposes. It is entirely possible those patients need to take those tests.

“However, if even a portion of the tests were for screening purposes, the authors’ findings provide useful information to patients and physicians on how frequently screening tests may lead to a care cascade,” Anderson and Lin wrote.

Read more: 

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• Where are patients more likely to receive low-value health services?
• Controlling benefit costs in 2020: Look at the big picture