The American College of Physicians (ACP), the largest U.S. medical specialty group, is trying to cut rising medical costs by developing a set of guidelines to help doctors better identify when patients should be screened for specific diseases and when they can be spared the additional high cost of these screenings.
Numbers show that excessive testing costs between $200 and $250 billion annually. Imaging tests like CT scans for lung disease, and overuse of routine electrocardiograms and other cardiac tests such as stress testing are among the top offenders when it comes to excessive costs. In some cases, screenings are not only unnecessary; they pose an additional health risk to patients. There are estimates that upwards of $800 billion, or one third of all healthcare spending, is wasted on unnecessary diagnostic tests and extra days in the hospital.
“It’s medical gluttony,” said Dr. Otis Brawley, chief medical officer of the American Cancer Society. But leaders in the ACP hope that, by cutting waste, they can avoid undesirable outcomes like “rationed medicine.” So where is the ACP focusing its attention?
Lower Back Pain
Back pain is very high on their list as a prevalent condition that requires expensive diagnostic evaluation that occasionally hurt patients. For instance, Medicare data shows that doctors often order MRI scans for patients with lower back pain who have not tried less invasive, less expensive treatments such as physical therapy. In fact, MRIs frequently led to surgery.
Screening for Colorectal Cancer
The CDC recommends three tests to find polyps or diagnose colorectal cancer: a stool test, once a year; a flexible sigmoidoscopy once every five years; or a colonoscopy every 10 years. Each test can be performed alone or in combination. The $10 stool test saves lives and is an effective tool, but in the United States most patients are undergoing the $3,000 colonoscopy. Even if the cheaper test is better, patients are still getting the expensive tests.
Defensive medicine, a practice in which physicians order additional tests instead of risking a lawsuit by overlooking a symptom, is also a large part of the proposed reform. While some patients share the blame of high costs by demanding additional tests and procedures, physicians could do more to emphasize the health benefits of positive lifestyle changes, like smoking cessation and weight loss, to help patients manage conditions or alleviate pain.
Source: Reuters, “Stemming the tide of overtreatment in U.S. healthcare”