It’s not a new conversation – if you thought back over the last few weeks, you probably could remember at least one healthcare-related chat. Almost as likely, that conversation will have included mention of the cost, time, or other burden that you, or someone you know, have experienced.
The cost of healthcare continues to rise. At the same time, patients and caregivers are becoming more informed regarding their own healthcare concerns, and engaging in much more interactive decision-making with their providers regarding treatment options. If they don’t already, these conversations should include ensuring a mutual understanding of what tests are being ordered, and what the usefulness of the test(s) will be for care decisions.
Overtesting is a widespread problem in the healthcare system today. It arises in any number of disease areas, and is a recurring issue of concern for many specialty societies regarding tests of interest to them. In fact, the American Board of Internal Medicine launched a campaign in 2012 called Choosing Wisely, with a goal of “advancing the national dialogue on avoiding wasteful or unnecessary medical tests, treatments and procedures.”
Ongoing efforts at Mayo Clinic to improve healthcare delivery and manage the cost of care have recently shed more light on some of these overtesting scenarios.
Led by Rozalina McCoy, M.D., Mayo Clinic primary care physician, endocrinologist, and health services researcher; a research team looked at the frequency of testing glycated hemoglobin (HbA1C) levels in adult patients with stable Type 2 diabetes. They found significant overtesting in a large, commercially-insured population, for which the testing not only was inappropriate, but had the potential to cause harm. Learn more about the study here (news release and video interview). This study was conducted using the OptumLabs™ Data Warehouse.
Dr. McCoy explains that patients and providers need to understand the issues that can arise with overtesting, and make well-informed decisions. She cites several potential concerns: (1) the test itself could result in complications, (2) the cost (financial or other resource burden) to the patient, provider and/or system may not be worth the information gained – especially pertinent with a test that carries little or no utility with over-frequent testing; (3) typically paired tests may also be redundant and carry other inconveniences (e.g. lipids panel requiring fasting); and (4) the real, and potentially fatal, risk of subsequent overtreatment.
The research team seeks to improve awareness of appropriate testing among both patients and providers, which in the long run will enhance their experience of healthcare delivery, improve health, and lower the overall cost of care.
Another recent Mayo Clinic-OptumLabs study looked at inappropriate testing for H. Pylori. That research team had similar concerns when observing that more than 73 percent of 500,000 people tested for H. pylori over a two-year time period, received a diagnostic blood test instead of the recommend stool antigen test or the urea breath test. These findings were concerning because the blood test carries a very high potential for misdiagnosis, and therefore incorrect therapy decisions.
These cases illustrate that an inappropriate test carries with it not only unnecessary cost, but potential health risks that could be avoided by better decision making. In the Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, the goal continues to be to build the evidence base in health care delivery, and to facilitate widespread dissemination of this evidence to improve health for people everywhere.