Health care costs in the United States have skyrocketed to more than $2 trillion a year -- up from $253 billion in 1980, and a fair amount of the increase can be attributed to unnecessary medical tests, according to a study published in today’s Annals of Internal Medicine. While many patients believe that doctors shouldn’t consider the price tag when their health is at stake, needless medical tests -- including cancer screenings performed too frequently or expensive imaging tests for vague back pain -- have led to a dramatic rise in health insurance premiums.
The average employee has seen premiums rise by 150 percent over the past decade. That’s money out of our own pockets to pay for tests and follow-up procedures that have little impact on how well we feel or how long we live.
“A high-cost intervention may provide good value if its net benefit (the extent to which benefits outweigh harms) is large enough to justify the costs,” wrote the journal’s editor in chief Dr. Christine Laine in an editorial that accompanied the study. “Conversely, low-cost interventions may provide low value if they have little or no net benefit.” Such low-value tests, she added, should be discontinued.
In the new study, a working group of physicians -- convened by the American College of Physicians -- identified 37 situations where the use of a medical test fails to provide high value, meaning the cost of the test, and its rate of false findings, doesn’t justify the benefits patients receive from it.
Here are some of the more common over-used medical tests identified by the working group. If your doctor recommends testing in one of these cases, you might want to get a list of reasons for why you need the test and how your treatment might change based on the results. (Often the answer is, it won’t.)
1. Annual cholesterol screening for those who have normal levels and aren’t taking cholesterol-lowering drugs like statins
2. Using magnetic resonance imaging rather than mammography in women at low to average breast cancer risk
3. Obtaining an electrocardiogram (EKG) to screen for heart disease in those who aren’t at high risk
4. Doing an exercise stress test in those who have low heart disease risk and who have no chest pain when exercising
5. Annual Pap smears to screen for cervical cancer in low-risk women, instead of every three years
6. Performing osteoporosis screening using dual-energy x-ray absorptiometry (DEXA) in women under 65 years old who aren’t at increased risk
7. Repeating colonoscopy within five years in those who have no signs of polyps
8. Screening for cervical cancer in low-risk women aged 65 or older and in women who have had a total hysterectomy (uterus and cervix) for benign disease
9. Performing blood tests for suspected early Lyme disease in those with vague symptoms
10. Screening for colorectal cancer or prostate cancer in those over age 75
11. Performing imaging studies like MRIs in those with nonspecific low back pain
12. Ordering a blood work-up in healthy patients undergoing elective surgery; these include a complete blood count, liver chemistry tests, and metabolic profiles
13. Doing a brain imaging scan to evaluate recurrent classic migraines in a patient who has a normal neurological examDeborah Kotz can be reached at firstname.lastname@example.org. Follow her on Twitter @debkotz2.