Unnecessary medical tests cost Washington patients $282 million during one-year period, study says

Cassie Sauer remembered waiting at Children’s Hospital in Seattle while her preschool-aged son was evaluated for a head injury.

He’d fallen off a play structure at school and lost consciousness after hitting his head on concrete. Doctors at the hospital ruled out a serious brain injury and told Sauer they didn’t recommend doing a CT scan of his head.

Sauer is the chief executive officer of the Washington State Hospital Association, which is working to cut down on unnecessary and wasteful medical tests and procedures across the state.

She is well aware that best medical practice recommends against CT scans for kids, because of the danger of radiation, unless there are other signs of a serious brain injury. But at the hospital, she found her instincts as a parent taking over.

“I was biting my tongue to not say, ‘No, you have to give a CT scan!’ ’’ she said. “It’s the right call to not do it, but most parents want it.”

Had she opted for the test, Sauer wouldn’t have been alone.

More than 622,000 Washingtonians received a medical procedure or test that was unnecessary during a one-year period, costing the health care system an estimated $282 million, according to a new report from the Washington Health Alliance.

The nonprofit’s report, published last Thursday, looked at claims submitted to private insurance companies between July 2015 and June 2016. Using a tool developed by Milliman, a private Seattle-based health data company, they analyzed claims for 47 procedures and tests that are typically considered unnecessary by medical professionals, including screening for cervical cancer more often than every three years and prescribing antibiotics for upper respiratory and ear infections.

Of the 1.52 million services they looked at, 45.7 percent were either wasteful or likely wasteful.

That’s not representative of all services patients receive, since the report specifically looked at services that are known to be overused. Since the information is based on private insurance claims data, it also excludes people on Medicare, Medicaid and those without insurance.

Still, it shows how just a few common procedures can drive up health care costs for everyone.

Just 11 of the 47 commonly unnecessary services looked at were responsible for 89 percent of the total cost. They include imaging for uncomplicated low-back pain in the first six weeks, annual electrocardiogram screenings in people with low risk and no symptoms of heart disease, and unnecessary imaging for eye disease.

The report is called, “First, Do No Harm,” and highlights the ways unnecessary care can be harmful to patients. Some wasteful procedures expose people to unnecessary radiation, but tests can also harm by causing anxiety and costing patients money, especially in an era where high-deductible health plans are increasingly common.

“A new CT scan might not cause you physical harm. You might have a week or two of mental anguish while you wait for someone to tell you it was inconclusive,” said Marcos Dachary, director of product management at Milliman.

Unnecessary tests also can produce false positives, causing people to spend more time and money on what eventually will be a negative diagnosis.

“We have a culture in health care that’s pervasive and that culture is more is always better,” said Susie Dade, deputy director of the alliance. “Both providers of care and patients fall into that trap and don’t necessarily discern when something isn’t adding value.”

In part, that’s thanks to a pervasive “better safe than sorry” attitude, which in patients can come from a desire for certainty, and in providers from a desire to avoid potential legal liability, Sauer said.

Patients also may not realize that best medical practices are constantly evolving based on new evidence.

The American Cancer Society has a lengthy page on its website showing a history of screening guidelines for breast, cervical, colon, lung and other cancers over the years. Annual pap smears for sexually active women under 30 were recommended until 2012, when the standard shifted to every three years starting at 21.

Dade said patients often don’t feel they can question doctors about the necessity for tests, or what a provider they’re referred to will cost.

She suggests patients ask five questions before getting a test or procedure done:

• “Do I really need it?”
• “What are the risks and possible side effects?”
• “Are there simpler or safer options?”
• “What happens if I do nothing?”
• “How much will this cost me, and will my insurance cover it?”

“All of those questions are perfectly reasonable questions for patients to ask, and yet too often they don’t ask them because they’re worried about what kind of reaction they’re going to get,” she said.

Sauer said the hospital association has been working on reducing common hospital-based tests and procedures that are often unneeded. She said nothing in the report was surprising, but laying out common forms of waste with images was helpful to show where change might be made.

Though they’re paid for services they perform, hospitals have incentives to cut down on unnecessary care, Sauer said. Many services, like labor and delivery, have a standard cost they charge insurers, so if the hospital is able to save by not adding unnecessary procedures in, they save money.

And few American hospitals are short on patients, she said.

“We don’t have enough staff. There’s a physician shortage, there’s a nurse shortage, there’s a tech shortage,” Sauer said. “We need to use our staff efficiently and not having our staff doing services that aren’t really beneficial.”