Blog | Wednesday, November 21, 2012

QD: News Every Day--Routinely repeating tests too hard a habit to break

Repeat testing is common among Medicare beneficiaries, with 55% having a second echocardiography within three years and 49% repeating a pulmonary function test, a study found.

Researchers conducted a longitudinal study of a 5% random sample of Medicare beneficiaries for the years 2004 to 2006 among the 50 largest metropolitan statistical areas to look at the proportions of the population tested and the proportion of tests repeated.

Results appeared online Nov. 19 at the Archives of Internal Medicine.

In addition to the half or more of patients who'd received a second echocardiography or pulmonary test, 44% of imaging stress tests were repeated within 3 years, 46% of chest computed tomographies, 41% of cystoscopies, and 35% of upper endoscopies.

Authors wrote, "Although we expect a certain fraction of examinations to be repeated, we were struck by the magnitude of that fraction: one-third to one-half of these tests are repeated within a 3-year period."

An editorial noted that financial payments are a major reason why. Practices don't feel like they can cut back without being paid in some other way than tests.

"To avoid reading an almost identical article about unwarranted geographic variations in these pages 10 years from now, physicians will need to support expansion of peer-designed active electronic clinical guidance systems and faster retirement of fee-for-service incentives," the editorial stated. "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."

Also driving overuse is the expectations of patients to be tested and treated. Donna Sweet, MD, MACP, recently attended a conference on overuse of five other tests and procedures, and reported some conclusions to Family Practice News.

Explaining the overprescribing of antibiotics, she said, "American patients aren't very patient. They want to be better now."