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Journal Article, Editorial: Stop Repeating Tests

November 26, 2012
Written by: , Filed in: Cardiac Imaging, Chest Radiology, Diagnostic Imaging
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Archives of Internal Medicine seems really fed up about excessive testing. A commentary published online last week begins:

After decades of attention to unsustainable growth in health spending and its degradation of worker wages, employer economic vitality, state educational funding, and federal fiscal integrity, it is discouraging to contemplate fresh evidence by Welch et al of our failure to curb waste of health care resources.

Authors Jerome P. Kassirer, MD, and Arnold Milstein, MD, are expressing—rather dramatically—their frustration about the findings of a study also published online in the Archive last week. Lead author H. Gilbert Welch, MD, and two co-authors looked at Medicare data from 2004 through 2006 regarding six diagnostic tests, including imaging stress tests and chest CT.

The authors found that the tests were frequently repeated within three years: 55 percent of the time for echocardiography, 49 percent for pulmonary function tests, 46 percent for chest CT, 44 percent for imaging stress tests, 41 percent for cytoscopy, and 35 percent for upper endoscopy.

Dr. Welch told Reuters Health:

Either these patients continually develop new problems or there are doctors who routinely repeat tests.

Routinely repeating such tests is not recommended absent a change in symptoms. However, it’s not unheard of that a doctor might order an extra test because a patient demands it or out of fear of being sued. A patient might even see a new doctor who doesn’t know about or can’t get the results of an earlier test.

And, of course, the fee-for-service reimbursement system provides a financial incentive for extra tests. “The fact is, we are paid to do more,” Dr. Welch said.

“Patients have understood the importance of not having unnecessary medications,” he continued. “But I think the general sense is, ‘Well, a diagnostic test can never hurt you.'”

However, each test carries a risk of uncovering an incidental finding that in turn leads to more tests and possibly unnecessary treatments. And imaging stress tests and CT can indeed in the long run hurt patients by exposing them to radiation.

Pressure to reduce tests will continue mounting. Which will squeeze radiologists and other health-care providers financially. That’s the reality that everyone will have to adjust to. When even medical journals start blaming you for “degradation of … federal fiscal integrity,” there just isn’t going to be any choice.

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