A study led by Washington state nonprofit group, Washington Health Alliance, recently concluded that in just one year more than 600,000 patients received medical treatment they didn’t need. Examples of treatment overuse included annual cervical cancer testing, lab work before elective procedures, or annual electrocardiograms and other heart tests for people who don’t need them.
To identify the issue of medical overuse or overtreatment, the group collected information from its All-Payer Claims Database for approximately 2.4 million commercially insured lives in the state of Washington using a tool called the Health Waste Calculator. The calculator is a part of the Milliman MedInsight suite of analytic tools and software designed to help identify and quantify overused health care services. The software was designed after health care spending estimates indicated that overuse could account for as much as one-third of total health care spending in the United States and contributes to the expensive rise in the cost of healthcare for all Americans. From the initial review, the group was then able to examine the cases of 1.3 million patients in Washington state who received one of 47 tests or services that medical experts flag as overused or unnecessary.
Study highlights include:
- More than 600,000 patients underwent a treatment they didn’t need, treatments that collectively cost an estimated $282 million.
- More than a third of the money spent on the 47 tests or services went to unnecessary care.
- Three of four annual cervical cancer screenings were performed on women who had adequate prior screenings — at a cost of $19 million.
- About 85 percent of the lab tests to prep healthy patients for low-risk surgery were unnecessary — squandering about $86 million.
- Needless annual heart tests on low-risk patients consumed $40 million.
Wasteful tests and procedures are a problem widespread. Across the United States, an estimated $765 billion a year of overuse has been identified by the National Academy of Medicine. That equals about a fourth of all the money spent each year on health care.
11 Key Drivers of Overtreatment
With the help of the Health Waste Calculator, Washington Health Alliance was able to identify 11 key measures (out of 47) that accounted for 93 percent of healthcare services. A total of 578,503 individuals in this study received at least one of these low-value services. As reported, the 11 measures include the following, in descending order based on volume:
- Too frequent cervical cancer screening in women
- Preoperative baseline laboratory studies prior to low-risk surgery
- Unnecessary imaging for eye disease
- Annual EKGs or cardiac screening in low risk, asymptomatic individuals
- Prescribing antibiotics for acute upper respiratory and ear infections
- PSA screening
- Population-based screening for OH-Vitamin D deficiency
- Imaging for uncomplicated low back pain in the first six weeks
- Preoperative EKG, chest x-ray and pulmonary function testing prior to low risk surgery
- Cardiac stress testing
- Imaging for uncomplicated headache
These common examples of overuse may be important when used to help the right patient but do not even slightly show the physical, emotional and extreme financial harm that can be done to individuals who do not need them.
Identifying Overuse Within a Care System
Overuse, also called overtreatment, is typically presented with low-value health care medical tests and procedures that have been shown to provide little benefit in particular clinical scenarios and in many cases have the potential to cause harm. Unfortunately, this issue resonates all too well to the heavily populated boomer generation, a group of people on limited incomes who are dependent on health care decisions and diagnoses to support affordable coverage. These individuals, or their caregivers, can help eliminate overuse from occurring by questioning their provider if the prescribed or suggested health care is:
- Supported by evidence;
- Truly necessary;
- Not duplicative of other tests or procedures already received; and
- As free from harm as possible
Although there are many assumptions and claims from both providers and patients that lead to unnecessary care, the United States medical system is still dominated by a payment system that pays providers for doing tests and procedures. Patients and their caregivers may also carry some responsibility for unnecessary treatments and overuse by demanding a medical professional help them by providing relief or perform a test to find a solution to a problem that may not – in actuality – really be there.
What Does This Mean for Illinois Residents
It’s no secret. Americans are having extreme difficulties affording valuable health care. Luckily, here in Illinois health insurance costs for the silver plan with the lowest monthly premium offered through the national or state-level insurance exchanges administered through the Affordable Care Act, ranks number 15 in the nation for best pricing. But don’t get too comfortable with that standing. Premiums will continue to rise as the opportunity to overuse becomes more prevalent.
Wasted medical care spending isn’t a random occurrence that happens in just a few locations. It has actually become normalized across the country so much that users are refraining from even thinking about it as an issue. But each day, hospital staff are pushing low-value health care treatments and billing for unnecessary tests while throwing away supplies and medications because they weren’t used within a specific yet falsified timeframe. Nursing homes and home care providers are just as big a contributor as they often discard still-potent medications or new equipment, to be paid for with the money in your loved one’s pocket.
When the cost for health care services continue to trend in a rising direction for everyone across the country, premiums for all plans will continue to increase. Patients and their communities need to demand dialogue among key stakeholders about how low-value, high-priced, wasteful health care tactics are impacting medical-related costs nationwide, but also right here in Illinois.
Respected Nursing Home Negligence Attorneys
Levin & Perconti has become one of the most widely-known and respected nursing home abuse and neglect law firms in Illinois, achieving multiple million dollar verdicts and settlements. If a loved one has been taken advantage of financially or you feel they are receiving unnecessary medical care that is causing them stress, physical or financial harm at a nursing home, we want to hear about it. There is a time limit to file a case in Illinois, so please contact us now for a free consultation with one of our skilled nursing home attorneys.