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Unnecessary Testing: the Physician-Patient Partnership

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To reduce waste in healthcare, both patients and doctors should do their part

In healthcare’s march toward accountable care, many see a low-hanging fruit to be reducing unnecessary testing. Thomson Reuters estimates that the U.S. healthcare system wastes between $250-$325 billion annually on unnecessary care in the form of diagnostic lab or imaging tests performed to protect against malpractice exposure or unwarranted surgical procedures. A 2010 survey of Consumer Reports readers—nearly 1,200 healthy 40 to 60-year-old men and women, with no known heart disease, risk factors or symptoms—showed that 44 percent had received screening tests for heart disease rated by Consumer Reports as very unlikely or unlikely to have benefits that outweigh the risks.

Shannon Brownlee, acting director, Health Policy Program, New America Foundation, a nonpartisan public policy institute based in Washington, D.C., characterized the U.S. healthcare system as a “remarkably inefficient and unproductive industry,” at the April 17 New York Ideas 2012 forum. “Healthcare is going to eat our lunch,” she said. “It accounts for about 20 percent of unemployment right now for the drag it exerts on private employers. It is eating into what states and federal can allocate for. The federal government now spends more on healthcare than on defense.”

To combat this issue of waste, many healthcare organizations have been employing physician performance management technology to power their clinical improvement and cost savings projects. One organization I spoke to, Virginia Hospital Center, has been using the Austin, Texas-based Crimson, a division of The Advisory Board Company, product and has reaped some rather impressive results. Virginia Hospital Center, a 342-bed facility in Arlington, Va., lowered its cost per case by 26 percent, and all told, saved more than $635,000 over the course of a year.

“Primarily, what we were looking for was waste in our system—where we were doing tests where we didn’t need to or were administering a drug where there was a cheaper, more appropriate alternative,” said Jeffrey DiLisi, M.D., vice president and chief medical officer. “The best example of that was the project we did in our ICU.”

As a part of this project, Virginia Hospital Center examined routine tests like chest X-rays and phosphorus blood tests that were being ordered frequently in the ICU and evaluated the necessity and frequency of these tests. “We were sort of [ordering these tests] by reflex every day,” said DiLisi. “One group of doctors that we really focused on was the residents. [They] sort of learn what to order every day, and keep on ordering it and ordering it; and you don’t necessarily need to do that.”

Virginia Hospital Center also reduced costs by using a less expensive form of the drug Pantoprazole, an acid inhibitor used to treat gastroesophageal reflux disease. The more expensive IV form was swapped out when appropriate with its oral counterpart, which can also be crushed and put down feeding tubes.

Providers aren’t the only ones that should be focusing on this issue of overspending. Public service campaigns, like "Choosing Wisely,” are trying to get the message out in the consumer sphere. As a part of Choosing Wisely, Consumer Reports and the American College of Physicians (ACP) recently partnered on an education initiative to help patients determine whether a medical test or procedure is necessary. The organizations have issued seven lists with evidence-based recommendations on when tests and procedures may be appropriate, as well as the methodology used in its creation.  

To reduce healthcare spending, we’re going to have to get both physicians and patients on the same page to understand that more care doesn’t necessarily equal better care. Evidenced-based guidelines and clinical decision support must be used when possible to give the appropriate care when needed.

Here’s a parting thought that I think sums up nicely this issue of wasteful healthcare spending:

What have you been doing in your hospitals or practices to reduce unnecessary testing? Leave a comment below to share your story.

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