Curbing unnecessary tests: Will that cut costs, improve care?

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Kaitlyn Dmyterko, senior writer

Striving to improve patient care is the primary goal for providers and hospital administrators, but doing so while still maintaining a revenue stream remains an acute pain point, particularly in an era of healthcare reform. How can hospitals effectively provide patients correct care without raising expenses? One way may be to start looking at unnecessary testing.

A study this week in the Archives of Internal Medicine explored the "top five" overused clinical activities and their costs. Researchers from Mount Sinai found that topping the list was brand name statin use and unnecessary testing. It was reported that one-year costs for unnecessary testing carried a $6.7 billion price tag; brand name statin use accounted for $5.8 billion of the costs.

Performing CT scans, MRIs or x-rays in patients with back pain accounted for $175 million in healthcare costs. How can we curb these high costs and increased number of perhaps unnecessary tests?

At this year’s American Society of Nuclear Cardiology (ASNC) scientific sessions, Robert C. Hendel, MD, of the University of Miami Miller School of Medicine in Miami, said that enforcing appropriate use may help.

While eliminating inappropriate imaging can help cut costs, it can also help reduce a patient’s exposure to radiation. “There is no radiation dose for tests not performed,” Hendel said. “Eliminating inappropriate imaging is the critical issue in radiation safety.”

Of the imaging exams performed, those deemed inappropriate may be between 11 and 24 percent, offered Hendel. He noted that educating clinicians on appropriate use criteria can reduce inappropriate imaging by 50 percent.

Along the same lines, Blue Cross and Blue Shield Association ( BCBSA) has issued a plan that moves the healthcare system away from a fee-for-service model to a patient-centered model. However, certain imaging groups have called on Congress to reject the BCBSA proposal for Medicare to use prior authorization for advanced imaging services. Debate on this tactic to garner $300 billion in savings is certain to roll on.

How much is too much? What is classified as overuse? Switching to generic drug forms rather than brand name drugs may be one strategy to cut costs, but what about unnecessary use of imaging? Knowing a patients' previous history and only performing tests when absolutely necessary and when indicated may be the solution.

On these topics or others, please feel free to contact me.

Kaitlyn Dmyterko
Cardiovascular Business, senior writer