Winter 2013

Repeat Testing a Waste

Medicare beneficiaries often receive unnecessary second round of diagnostics

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Photo: iStockPhoto

A recent study argues that diagnostic tests are too often repeated among Medicare beneficiaries, according to a report published online by Archives of Internal Medicine.

H. Gilbert Welch of Dartmouth College and colleagues looked at patterns of repeat testing in a longitudinal study of a 5 percent random sample of Medicare recipients in a selection of 50 metropolitan areas. “We examined repetitive testing for six commonly performed diagnostic tests in which repeat testing is not routinely anticipated,” the authors wrote. “Although we expected 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 three-year period. This finding raises the question whether some physicians are routinely repeating diagnostic tests.”

Among patients undergoing echocardiography, for example, 55 percent had a second test within three years. Forty-four percent of imaging stress tests were repeated within three years, as were 49 percent of pulmonary function tests. Findings varied markedly by metropolitan area.

Repeating testing so frequently “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 authors wrote. “Although the tests themselves pose little risk, repeat testing is a major risk factor for incidental detection and over-diagnosis.”

In an accompanying commentary, Jerome P. Kassirer of Tufts School of Medicine and Arnold Milstein of Stanford University sounded an exasperated note, writing, “After decades of attention to unsustainable growth in health spending and its degradation of worker wages, employer economic vitality, state educational funding and fiscal integrity, it is discouraging to contemplate fresh evidence by Welch et al of our failure to curb waste of health-care resources.

“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.”

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