Put medical testing to a financial means test

After two days of trying to control my daughter's 103-degree fever, my wife and I didn't shoot down a flu test when she was examined at the doctor's office--even though we were told it was only to get "more information." We were tired and therefore off guard.

The test came back negative. We wound up with an extra charge on our office bill. It was knocked down more than 70 percent by our insurer, but it still tacked on another 30 percent to what we would have to pay out of pocket for a routine office visit.

I often wonder how many millions of times a year procedures like flu tests are performed at doctor's offices, even though the course of treatment is pretty much exactly the same no matter the result.

Hospitals engage in overtesting as well. In fact, it's rampant, Leana Wen and Joshua Kosowsky, both emergency room physicians at Brigham and Women's Hospital in Boston, argued in  "When Doctor's Don't Listen." They pointed to treatment algorithms--such as for a cough or chest pain--that almost invariably lead to a test of some sort.

And there also is the commonplace practice of defensive medicine for doctors and hospitals to avoid malpractice litigation.

There aren't any exact numbers on overtesting floating around, but organizations such as the ABIM Foundation recently disseminated more than $1 million in grants to state medical societies to try and get physicians to cut down on unnecessary tests. Although flu diagnostics aren't on there, the ABIM so far compiled a list of 130 overused tests--and counting.

If a test isn't overused, sometimes a diagnosis is. A recent study by researchers at the University of Michigan and the University of Missouri concluded that pediatricians are overdiagnosing gastroesophageal reflux disorder, or GERD, in infants suffering little more than common spitting up. As a result, parents are asking for medication to treat this condition--something that can elevate the risk of pneumonia in the little tykes.

Add to this the emergence of personalized medicine--molecular-based tests that can detect an individual's genetic disposition to thousands of medical conditions or reactions to treatment --and overtesting is likely to continue unabated in the coming decades.

Hospitals are in a difficult position in regards to this issue. Testing is a source of reliable revenue, and it still seems like a good business proposition to overutilize a $25 test rather than spend $25,000 to defend a questionable patient lawsuit. But given the number of patients with large deductibles and out-of-pocket costs, it is no longer fair to them to perform tests without an actual purpose behind them.

There are a variety of ways for hospitals to continue to embrace testing while using it to improve their own bottom lines. Systems such as Memorial Healthcare in the Miami area have avoided millions of dollars in additional costs since it installed an aggressive testing system for hospital-acquired infections about five years ago--dramatically cutting down its rates of MRSA in the process.

The healthcare industry engages in testing for the purpose of information gathering, whether it is to find out if someone has the flu or how to best treat a heart attack victim. But healthcare's financial equation can no longer input information that isn't actionable. Its financial gatekeepers should proceed accordingly. - Ron (@FierceHealth)

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