Fewer Tests for Patients

Excerpt from "Doctor Panels Recommend Fewer Tests for Patients," New York Times, by Roni Caryn Rabin. April 4, 2012--In a move likely to alter treatment standards in hospitals and doctors’ offices nationwide, a group of nine medical specialty boards plans to recommend that doctors perform 45 common tests and procedures less often, and to urge patients to question these services if they are offered. Eight other specialty boards are preparing to follow suit with additional lists of procedures their members should perform far less often. The recommendations represent an unusually frank acknowledgment by physicians that many profitable tests and procedures are performed unnecessarily and may harm patients. By some estimates, unnecessary treatment constitutes one-third of medical spending in the United States.

“Overuse is one of the most serious crises in American medicine,” said Dr. Lawrence Smith, physician-in-chief at North Shore-LIJ Health System and dean of the Hofstra North Shore-LIJ School of Medicine, who was not involved in the initiative. “Many people have thought that the organizations most resistant to this idea would be the specialty organizations, so this is a very powerful message.” Many previous attempts to rein in unnecessary care have faltered, but guidance coming from respected physician groups is likely to exert more influence than directives from other quarters. But their change of heart also reflects recent changes in the healthcare marketplace. Insurers and other payers are seeking to shift more of their financial pain to providers like hospitals and physician practices, and efforts are being made to reduce financial incentives for doctors to run more tests. “Any information that can help inform medical decisions is good — the concern is when the information starts to be used not just to inform decisions, but by payers to limit decisions that a patient can make,” said Kathryn Nix, healthcare policy analyst for the Heritage Foundation, a conservative research group. “With healthcare reform, changes in Medicare and the advent of accountable care organizations, there has been a strong push for using this information to limit patients’ ability to make decisions themselves.”

“These all sound reasonable, but don’t forget that every person you’re looking after is unique,” said Dr. Eric Topol, chief academic officer of Scripps Health, a health system based in San Diego, adding that he worried that the group’s advice would make tailoring care to individual patients harder. “This kind of one-size-fits-all approach can be a real detriment to good care.” Many commended the specialty groups for their bold action, saying the initiative could alienate their own members, since doing fewer diagnostic tests and procedures can cut into a physician’s income under fee-for-service payment schemes that pay for each patient encounter separately. “It’s courageous that these societies are stepping up,” said Dr. John Santa, director of the health ratings center of Consumer Reports. “I am a primary care internist myself, and I’m anticipating running into some of my colleagues who will say, ‘Y’ know, John, we all know we’ve done EKGs that weren’t necessary and bone density tests that weren’t necessary, but, you know, that was a little bit of extra money for us.’”

Campus & Community Ministries National Director J. Scott Ries, MD: "'Just because we can, doesn’t mean we should.' An often spoken phrase, but when considered in regard to medical tests and procedures, seemingly rarely followed. I do not recall the last time I heard a colleague deny the unsustainability of our current healthcare economics. Yet, when was the last time we put our own ordering patterns under the microscope?

"There exist three potential outcomes of the decision to order a test or a procedure:
1. It will clearly influence the treatment of the patient.
2. It may (or may not) influence recommended intervention for the patient.
3. There will likely be no change in course of treatment, regardless of its result.

"What factors might motivate our decision? Would we ever really consider ordering a test in the third category? Consider these influencers of our decision making:
•Fear of litigation
•Patient demands
•Profitability for the doctor, practice or hospital
•Confusion regarding the value or indication of the test or procedure itself

"An honest look at how some of our ordering patterns compare to the recommendations from the affiliated specialty partners of the ABIM-Foundation may prove insightful.

"As followers of Christ, maintaining a kingdom-oriented view of our practice is instrumental in becoming more like the Great Physician. 1 Thessalonians 5:22 reminds us, “...don’t be gullible. Check out everything, and keep only what’s good...” (MSG). To avoid even 'the appearance of evil' we must carefully guard our professionalism and integrity, even to the selection of tests we order. Others (beyond tort attorneys) are watching, including the students and residents we are influencing."

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CMDA Ethics Statement: Principles of Christian Excellence in Medical & Dental Practice