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Millions squandered in unnecessary tests ordered in routine doctor visits

urvey (NAMCS) sponsored by the Centers for Disease Control. They analyzed 4,617 general examination visits by adults over age 20. The researchers then looked at how many of the "D" category tests -- urinalysis, EKG, and X-rays-- were ordered, and found at least one of the three D interventions was ordered 43-46% of the time.

The researchers then extrapolated their findings into a national picture of use, and estimated that annual direct medical costs for the three "D" category tests those whose use the panel recommended against -- ranged from $47 million to $194 million. Adding the other two tests, those in the "C'' category urinalysis and blood tests--added an additional $12-$63 million.

What the numbers miss, however, according to researchers, are the various costs that occur when a test is false positive − that is, wrongly shows evidence of a health problem. For example, studies show that 20-30 percent of EKG tests result in false positive results, and patients with these results usually have follow-up exams that are much more expensive, Merenstein says.

"We estimate that if 20 percent of EKGs are false, the follow-up tests will cost about $683 million, and that doesn't account for the stress that a patient feels, the time off from work they have to take, and the possible complications that result from the follow-up test."

Among their other findings is that men are given more of these tests than are women, and that Hispanics are also offered more tests than non-Hispanic patients.

Merenstein and his two co-authors say among the many reasons that diagnostic interventions which lack evidence of benefit in asymptomatic patients are used are:

  • Studies have shown that many patients have expectations of receiving particular tests when visiting physicians.
  • It is possible that physicians are ordering these tests defensively, to guard against potential lawsuits.
  • Physicians may not be
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Contact: Liz McDonald
eem6@georgetown.edu
202-687-5100
Georgetown University Medical Center
19-May-2006


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