Some doctors may be milking their better-insured patients. When looking at 2013 insurance claims from nearly 1.5 million adults with commercial insurance, researchers found that just under 8% of people had received “low-value services,” with the research defined as providing little value to patients, given all the costs and alternatives.
Those medical services can include hormone tests for thyroid problems, X-rays or MRI scans for lower-back pain, and brain scans for uncomplicated headaches, according to the study, published Monday.
All told, the costs for 28 low-value medical services studied accounted for 0.5% of total spending, the researchers discovered. Though this may seem minuscule, the costs add up, esulting in $32.8 million of spending in 2013 alone.
Not enough vs. too much
“The important caveat to highlight is, we’re only looking at 28 services,” said Rachel Reid, lead author and a policy researcher at Rand Corp. “We’re looking at a very small slice, but it can give you a lens on the larger problem.”
As Reid and her colleagues referenced in their research, a previous report estimated that more than $750 billion of the total $2.5 trillion spent annually on health care in the US represents waste.
Reid’s study noted that in dollar amounts per service, spending on spinal injections for lower-back pain totaled $12.1 million, scans for headaches $3.6 million and imaging for low-back pain $3.1 million — each part of the total $32.8 million in wasted health care dollars.
Another discovery: Low-value spending was lower among patients who were older, male, black or Asian, lower-income or enrolled in high-deductible health plans. “Regionally, the Southern, Middle Atlantic and Mountain regions had greater proportionate low-value spending,” wrote the research team.
Health care disparities “cut both ways,” Reid said. Some underinsured patients are not getting enough health care, while highly insured patients may be getting an abundance of poor-quality care.
Though the study focused on, in Reid’s words, only “a narrow slice” of services, these low-value diagnostic tests or treatments give a sense of the greater range of poor-quality health care being dispensed across the nation, she said.
“As we strive to curb overuse, one area ripe for intervention may be how we communicate with patients about medical decisions, particularly those related to low-value care,” Drs. Anna L. Park and Patrick G. O’Malley wrote in an editorial accompanying the research, published in JAMA Internal Medicine.
According to Park and O’Malley, doctors may lack the skills to discuss risks and benefits of diagnostic tests and treatments with their patients.
Cha-ching!
“Medicine is hard, and there’s so much individual variation and so much money sloshing around and so many people wanting to get their hands on it, so it’s hard to know who to believe,” said Dr. Jane Orient, executive director of the Association of American Physicians and Surgeons.
Orient, who also works as an internist in private practice, explained that doctors are influenced by many factors when discussing tests and treatments with their patients. Sometimes, for instance, a patient asks for a certain test.
“What, are you supposed to say, ‘No’?” she asked, noting that “failure to diagnose is one of the most common reasons for filing a lawsuit, so there is a lot of pressure [on doctors] to, if you think of something, to do it.” She also said some patients in high-deductible plans may refuse tests, despite a doctor’s recommendation.
Another important issue: Self-appointed committees that decide which treatments or procedures are low-quality may have conflicts of interest ,or no direct responsibility for patients, so their guidelines may not always be valid.
More importantly, treatment recommendations and guidelines “can change quite dramatically” over time, explained Orient. As an example, she noted that a radical mastectomy was once considered the only treatment for all breast cancer, yet today, some patients are successfully treated with a lumpectomy.
She does believe all doctors would benefit from learning how to read and interpret scientific studies and the potential risks and rewards for actual patients. As she sees it, medical schools currently do not provide that kind of training.
Not only are doctors inadequately prepared, they may be feeling discontented. In 2013, a report from Deloitte Center for Health Solutions suggested that doctors are increasingly dissatisfied with their jobs. Three-quarters of doctors said they believe the best and brightest may not consider a career in medicine, an increase from 69% in 2011, according to the report. Deloitte also noted that four in every 10 doctors said their take-home pay decreased from 2011 to 2012. Notably, the majority did not blame the Affordable Care Act.
“Doctors don’t get paid for looking at patients and doing the best they can; they get paid for following insurance companies’ recommendations,” said Orient. “It’s terrible.”