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Monday, April 9. 2012

Medical costs in America, and the tests you don't need

We linked this NYT op-ed this morning: Do You Need That Test?


Of course expensive and extensive testing is ordered, these days, partly because of malpractice. Any doc will say so. It's about CYA.


As a consequence, young docs are being trained to rely more on the tests they can order than on old-fashioned inexpensive clinical, hands-on evaluation and diagnosis. Thus a vicious cycle begins. And it's all free, because "insurance pays for it." So you get the patient's family in on it too: "Doc, we want you to do every possible thing and do every possible test to check out Granny." Is that an argument a physician wants to have?


No doctor enjoys being on the witness stand answering the question "So, Dr., you elected not to order a CAT scan for Mrs. Jones' headache because you trusted your clinical judgement, and felt the expense-benefit ratio was wrong?"

Posted by Dr. Joy Bliss in Medical, Our Essays, Psychology, and Dr. Bliss at 15:22 | Comments (9) | Trackbacks (0)

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Yup. Also, Don't forget that the insurer/MCARE won't pay you for the 30 minute conversation to explain that Grandma doesn't need the test vs the 10 sec to see "sure let's order one".
#1 MDJD on 2012-04-09 17:56 (Reply)
About a year and a half ago my husband was in the hospital for six weeks because of an abdominal aortic anuresium. About a week before he was to be released we we informed he would need a walker, tub chair, toilet seat and a wheel chair. I asked if it wouldn't be a good idea to see if we could borrow these things from people we knew. They immediately said oh no you don't want to do that because they have to be the right size and besides insurance will pay for it. Insurance would not pay for three of those items because we are not on Medicare. We were able to borrow a walker from our neighbor and the other items from the local VFW. They have a shed full of these items and will lend them out out at no cost. Of course when we returned them we made a donation. I was disgusted at the attitude from the health care staff. We all can make a difference but there is little encouragement to do that.
#2 Nana on 2012-04-09 18:08 (Reply)
I applaud your initiative.
#2.1 inthehills on 2012-04-10 02:48 (Reply)
It was interesting seeing some of the comments regarding the article...basically: "if they cut any of these tests medical tests, they'll kill people." With all the scare mongering that goes on these days...this might happen, that might happen, far too many people are irrationally fearful of very safe circumstances. Getting people to pay more for their own health care is the only serious way to cut costs. Even if Nana had insurance to cover those necessary items, would her insurance say...if you provide those yourself, here's back 20 percent or even 50 percent of what it would have cost us. Letting the consumer of medical care judiciously benefit from cutting costs will be the only way to cut costs.
#3 Mark on 2012-04-09 23:37 (Reply)
Very good point.
#3.1 inthehills on 2012-04-10 02:51 (Reply)
It's unfortunate that conservatives attack every attempt to reduce unnecessary tests and procedures as leading to "death panels." There is plenty of evidence to show that these tests and procedures actually harm patients. A good book on this topic is RETHINKING AGING by Norton Hadler.

One obstacle to reducing the cost of medical care (not the same as eliminating unnecessary tests and procedures) is the disease lobbies, the Komen model now adopted by all other groups. They have the public megaphone, plenty of money, and a willingness to manipulate statistics to make their case.

There are more of them every year too.
#4 lhf on 2012-04-10 07:39 (Reply)
THe conservatives I know don't want to reduce the number of tests ordered until there is serious talk about tort reform. The liberals make the argument that lawsuits only cost doctors so much money per year, so it is insignificant. But if I was an obstetrician, I would perform as many tests as I could and be standing by with a scalpel to do a C-Section lest John Edwards jumps out from behind the curtain and serves me.

The fact of the matter is that medicine is a very inexact science. Until we, as a society, accept that fact and accept that awards in the tens of millions of dollars are excessive, then we will not have affordable health care. Doctors are going to continue to order unneccesary tests to avoid lawsuits. Doctors are going to continue to drop out of high risk practice until the only ones left are the ones that you pay a premium to see. Insurance companies are going to continue to raise their premiums to cover all the testing. Malpractice insurance premiums are going to continue to rise, causing doctors to charge more for an office visit.

Will this fix all the healthcare cost problems? No. Absolutely not. But it will do a lot more for it than what forcing a healthy twentysomething to buy health insurance so his grandmother can be covered.
#4.1 TPH on 2012-04-13 09:57 (Reply)
Just over the horizon: Checking the political affiliation of doctors before taking their advice.
Don't laugh.
It's coming.
#5 PacRim Jim (Link) on 2012-04-10 12:42 (Reply)
Yep, they have tried more than once to force all medical schools to make sure that only approved "abortion friendly" doctors are admitted.

And I don't know of any conservatives who want to waste money where it doesn't need to be spent.

Tort reform would save money, and all the Conservatives I know are for it. All of the progressives, communists, socialists and anarchists I have heard speak on the issue want more lawsuits, not less. Like John Edwards, they seldom mention suing doctors. They are only suing insurance companies.
#6 tyree on 2012-04-11 01:19 (Reply)

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