Mass. doctors routinely order extra tests, report says
Massachusetts health care providers routinely order wasteful and unnecessary medical tests and procedures, driving up costs, according to a new report from the state Health Policy Commission.
The findings released Wednesday offered new details about what’s called nonrecommended care. Most of the state’s large physician and hospital networks, especially Partners HealthCare, Lahey Health, and Steward Health Care System, regularly ordered unnecessary tests and procedures, the report said.
The providers who performed best in this measure were Boston Medical Center and the physician group affiliated with Mount Auburn Hospital and Cambridge Health Alliance. The analysis, which was based on insurance claims data, included imaging tests and spinal injections for common lower back pain, cervical cancer screenings for women under 21, and several other tests and procedures that were considered unnecessary.
The findings “highlight an opportunity to reduce spending while actually improving the care for patients,” said David Seltz, executive director of the Health Policy Commission, a watchdog agency that tracks health costs. “Our goal is that organizations will identify areas of unnecessary care and take steps to make improvements.”
The overuse of medical tests and procedures is a concern nationwide. A 2014 Harvard study found that one-quarter of people on Medicare, the government program for seniors, commonly received treatment that was likely to provide minimal or no benefit. “Wasteful practices are pervasive in the US health care system,” the study said.
Some of the health care providers named in the Health Policy Commission’s report challenged the findings and noted that it relied on data from 2013.
“Screenings, surgeries, and lab tests are all important aspects of keeping people healthy,” said Rich Copp, a spokesman for Boston-based Partners, the parent of Massachusetts General and Brigham and Women’s hospitals. “We’ll take a closer look at the data in this report, but decisions about medical care will always be made as part of the doctor-patient relationship.”
Steward spokesman Jeff Hall said in an e-mail that the figures “no longer reflects current trends,” and that “Steward remains significantly more affordable than competitors for these kinds of services.”
Lahey spokesman Chris Murphy
The report was dated but still helpful, said Lynn Nicholas, president of the Massachusetts Health & Hospital Association. “This is definitely something we should monitor over time,” she said.
Nicholas and others said doctors and hospitals are getting better at reducing unnecessary tests and procedures as they adopt new payment models that push them to provide more efficient care under set budgets.
Doctors order tests and procedures beyond what’s recommended for patients for a variety of reason, experts said. It could be out of habit, to meet a patient’s demand, or to avoid malpractice litigation.
Boston Medical Center controlled wasteful spending more successfully than other health systems because it has gotten used to living on a tight budget, said Dr. Ravin Davidoff, chief medical officer. BMC serves a large population of patients on Medicaid, the government health program for the poor, which pays hospitals less than commercial insurers pay for the same services.
“For us, we had maybe two or three MRIs at Boston Medical Center,” Davidoff said. “Some of the places in town have 10, 12 MRIs. We’ve had to think very carefully. We’ve always been very deliberate about how we allocate resources.”
The Health Policy Commission’s wide-ranging report noted that Massachusetts health costs grew more slowly than costs nationwide in 2015, but health care remains more expensive here than in other states. The growing costs of prescription drugs drove spending higher in 2014 and 2015, the report said.
Massachusetts residents also used hospitals at a higher rate than the national average, and much of that care was delivered in large urban teaching hospitals even when a community hospital would have been appropriate, the commission said.