Unnecessary Care in Healthcare is Costing Patients $210B a Year

Who’s to blame for unnecessary tests and procedures in the healthcare system? And how do you minimize unnecessary medical care at your ED?

What’s going on with unnecessary tests and procedures in the healthcare system?

From duplicate screenings, scans, and blood work to treatments and surgeries with little benefit, millions of patients and providers have been victims of overuse in healthcare[*].

One report from the Institute of Medicine shows “unnecessary services” cost the US healthcare system over $210 billion[*].

As the single biggest contributor to waste annually, unnecessary medical testing and medical care must be avoided at your emergency department.

What Defines Unnecessary Tests and Procedures in the Healthcare System?

Experts define unnecessary tests and procedures in the healthcare system as those which do more harm than good for patients and drive up healthcare costs.

This covers testing, prescriptions, procedures, admissions, referrals to specialists, therapy, and much more.

The Washington Health Alliance (WHA), a nonprofit hoping to make healthcare more transparent and affordable, flagged almost 50 tests and services as overused or unnecessary.

They reviewed insurance claims from over one million patients in Washington state and learned[*]:

  • Patients logged over 600,000 unnecessary treatments, for a cost of $282 million.
  • 85% of the lab tests to prep healthy patients for low-risk surgery were deemed unnecessary and cost $86 million.

An analysis of the Virginia All-Payer Claims Database in 2014 revealed more than $586 million in unnecessary costs.

It also highlighted the fact that low- and very low-cost services ($538 or less each) were delivered more frequently (65% of the time) than services that were high- and very high-cost ($539 or more)[*].

Inexpensive tests here and there add up. When you order one test, what more is ordering a second? Or even a third?

This wasted healthcare spending drives up health care costs at a rate that’s outpacing inflation. 

Consequences of Unnecessary Care in Healthcare

Unnecessary care causes:

Higher financial costs. Additional healthcare costs raise insurance premiums for patients. Employers then struggle to provide healthcare for their employees. Fewer patients can afford insurance.

Patient harm and lower patient satisfaction. Patients are subjected to unnecessary probing, prodding, testing, procedures, and anxiety about what all of it means (or how much it will cost). 

They’re also given unnecessary drugs that may have adverse side effects. Others provide no medical benefit and contribute to issues like the overuse of antibiotics[*].

Distrust in the medical community. Ordering extra tests and procedures doesn’t always guarantee a diagnosis or solution for treatment. If patients are forced to pay for care that doesn’t help, they may be less likely to agree to care when it’s necessary.

Unnecessary tests have no benefit and harm everyone.

So who’s responsible for it?

Who’s To Blame For Unnecessary Care in Healthcare? The Answer Isn’t That Simple.

Experts believe unnecessary care in healthcare results from three converging issues:

Doctors Taking A Proactive Approach To Avoid Malpractice

Some say doctors feel pressure to do more for fear of being sued for missing something or not doing enough[*].

Researchers from Johns Hopkins and Harvard surveyed over 2,000 physicians in the American Medical Association about unnecessary medical care, overtreatment, and overutilization.

They published their findings in PLOS one and revealed that physicians deem 20% of the medical care provided today as unnecessary[*].

The most commonly reported unnecessary care was: 

  • Tests 24.9%
  • Prescription medications 22%
  • Procedures 11%

So why did the physicians admit to recommending unnecessary tests, drugs, or procedures?

  • 85% said fear of malpractice
  • 59% blamed patient pressure and requests
  • 38% had difficulty accessing medical records of prior patient care

After the fear of malpractice and trouble locating patient records, doctors must also contend with patient demands.

Patients May Also Bear Some Responsibility

When a “wait and see” approach isn’t acceptable, doctors may feel pressured to appease upset patients with a placebo. So they run tests or provide unnecessary medical procedures.

Other times, doctors overestimate the level of care patients expect. If a physician believes a patient wants care, they will agree to it, which then confuses the patient into thinking it’s necessary.

In one study, doctors prescribed antibiotics when they felt patients “expected” them. Consequently, patients who received antibiotics gave 100% patient satisfaction scores[*].

There’s also the less-than-savory elephant in the room: monetary incentive. 

Reimbursement and Financial Incentives Reward Physicians Who “Do” More

Over 70% of physicians in the survey mentioned earlier believe physicians are more likely to order unnecessary medical procedures or care if they can profit from them[*]. 

Others blame the insurance system. 

With a reimbursement system that pays physicians for the tests and procedures they perform, many order all those that seem relevant to their patient’s presenting symptoms. The more a physician seems to “do”, the more he or she may earn.

So how can those in healthcare lessen or even stop this?

How To Stop Unnecessary Medical Care at Your ED

The physician survey also asked doctors to suggest potential solutions to the unnecessary medical care crisis.

Since most believe physicians are more likely to perform unnecessary procedures when they profit from them, de-emphasizing fee-for-service compensation may reduce health care utilization and costs[*].

Some experts say healthcare should transition from a volume-based reimbursement model to paying for the value provided instead. Or at least minimize the financial incentives physicians receive from unnecessary care.

Additionally, the physicians said these ideas may also help[*]:

  • Training residents on appropriateness criteria (55.2%)
  • Easy access to outside health records (52%)
  • More practice guidelines (51.5%)

Patients can do their part too.

Physicians from the American Board of Internal Medicine (ABIM) Foundation established the Choosing Wisely campaign to decrease the use of inappropriate tests and procedures.

This database offers explanations about how to avoid 500 common unnecessary practices[*]. 

Over 80 medical societies are on board with this proactive approach and encourage physicians to share this intel with their patients.

How Much Is Your ED Spending On Unnecessary Healthcare?

Rooting out unnecessary healthcare at your emergency department could make a significant difference to your bottom line. 

But you have to pinpoint the leaks to know where to start plugging them.

If you don’t know where to begin, start with a complimentary practice analysis from DuvaSawko today. 

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