Your Doctor Could Be Making A Profit From Tests You Don’t Need

Doctor_examines_patient_(1)Some doctors may be trying to get more money out of their better-insured patients than is necessary. A study conducted by Rachel Reid, lead author and policy researcher at Rand Corp, showed that almost 8% of people had received “low-value services” in 2013. The statistics were based on 2013 insurance claims from nearly 1.5 million adults with commercial insurance. The researchers defined “low-value services” as services that provided little value to patients, given the costs and the alternatives.

These services can include anything from brain scans for uncomplicated headaches to hormone tests for thyroid problems to X-rays or MRI scans for lower-back pain. The researchers found the costs for the 28 low-value medical services studied made up 0.5% of total spending. This may not seem like much, but it adds up. In 2013 alone, it added up to $32.8 million of spending. The researchers referenced a previous report which estimated that of the total $2.5 trillion spent each year on health care in the US, over $750 billion represents waste.

Needless to say, underinsured patients are largely affected by health care disparities. Many underinsured patients do not receive enough healthcare. Highly insured patients, on the other hand, may get a huge amount of poor-quality care. In an editorial accompanying the research, Dr. Anna L. Park and Dr. Patrick G. O’Malley wrote that doctors need to communicate with patients about medical decisions, especially those regarding low-value care. Some doctors do not have the skills to discuss the benefits and the risks of diagnostic tests and treatments with their patients.

According to Dr. Jane Orient, who is the executive director of the Association of American Physicians and Surgeons, patients often have difficulty knowing who to believe because there is a lot of individual variation. Add to that a huge number of doctors and a substantial amount of money that those doctors want to get their hands on and you’ve got a pretty jumbled situation.

Dr. Orient added that doctors are influenced by a number of factors when discussing treatments and tests with their patients. Sometimes a patient will ask for a certain test. At this point, it can be hard to go against the patient’s wishes, especially given that the failure to diagnose can often lead to a lawsuit. Doctors are under a lot of pressure to test for anything they think might be possible. In addition, some patients may refuse tests despite the doctor’s recommendation because they are in high-deductible plans.

Another issue is the possibility of biases within the committees that decide which treatments or procedures are low-quality. These committees are self-appointed, so their guidelines may be skewed by conflicts of interest or by a lack of direct responsibility for patients.

There is a lot to consider before implementing a way to prevent patients from spending on “low-value services.” But one thing that can be taken away from this study is that doctors need to learn to read and interpret scientific studies in a way that allows them to know the potential risks and rewards for patients. Dr. Orient believes medical schools do not provide enough of this type of training. Clearly there’s still a lot of think over, but equipping doctors with the skills to help their patients in the best way they can would be a big first step in the right direction.