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Costly, Repeat Medical Testing Common for Medicare Patients: Study
Date:11/20/2012

rcent of those who had a lung function test and 46 percent of those who had a chest CT scan. Forty-one percent of those who had a bladder test called a cystoscopy and 35 percent of patients who had an endoscopy of their digestive tracts had these exams more than once.

Testing varied by geography. For example, patients in Miami tended to have more echocardiograms, while patients in Portland, Ore., had the fewest.

"Diagnostic tests are frequently repeated among Medicare beneficiaries. This has important implications not only for the capacity to serve new patients and the ability to contain costs but also for the health of the population," the study authors concluded.

The authors noted that while the tests themselves pose little immediate risk, "repeat testing is a major risk factor for incidental detection and overdiagnosis."

In an accompanying journal editorial, Dr. Jerome Kassirer at Tufts University and Dr. Arnold Milstein at Stanford University wrote that "it is discouraging to contemplate fresh evidence . . . of our failure to curb waste of health care resources."

The editorialists recommend new and better physician guidelines and the end of payment incentives tied to services performed -- such as tests.

Fitterman agreed. "The 800-pound gorilla in the room is that we live in a fee-for-services world; there are financial incentives to do repeat testing," he said.

Part of the answer is to move away from fee-for-service and replace it with practice-redesign using evidence-based guidelines, Fitterman added. And he suggested limiting malpractice liability when doctors follow these guidelines.

Kassirer and Milstein concluded: "No matter what future payment system is implemented, some intercession in clinical decision making will be required to protect patients from too many tests and from too few tests. We have not come close to getting it right."

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