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Bankrupt Health Care
Medical Testing Run Amok in Florida

When it comes to unnecessary medical testing, not all states are created equal. In the NYT, Elisabeth Rosenthal reports that in Florida “more than twice the number” of certain kinds of tests “were ordered per Medicare beneficiary in doctor’s offices in Florida than in Massachusetts.” The NYT story zooms in to look at the experience of retirees who spend the winter in Florida—but even though the problem is worse in Florida than elsewhere, these kinds of testing patterns are national:

High-volume testing is also a good way for physicians to supplement income when insurers are cutting back on payments for individual services. From 1999 to 2008, as Medicare reduced reimbursement for many cardiology services, one study found that the number of Medicare claims soared for the types of testing recommended to Ms. Spencer’s husband. Claims for echocardiograms (which use sound waves to produce pictures of the heart’s wall and valves) increased by 90 percent. Peripheral vascular ultrasound tests (which look for clogged arteries) nearly tripled. Nuclear stress testing (a complex test for coronary artery disease) more than tripled, even though the procedure takes hours, involves an injection and radiation exposure, and costs thousands of dollars.

David Goldhill has analogized this approach to health care policy as trying to “squeez[e] certain areas of a balloon while it’s being pumped with air.” Top-down attempts to control costs through federal mandates will always run into this problem. Unless American patients become smarter consumers of health care services, providers will find ways to evade targets set by experts. That is why it’s encouraging to read in this article that some Americans wintering in Florida are increasingly less willing to submit to tests that their doctors at home never recommended. If it is widespread enough, that caution will help bring down costs, implicitly rebutting the claim that patients can’t be consumers. More of that kind of caution is necessary to bring down costs and improve the quality of Americans’ health care experiences.

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  • FriendlyGoat

    May everyone have decent insurance for contingencies AND voluntarily stay as far away from doctors and medical corporations as possible.

    • Andrew Allison

      You confuse (surprise, surprise) two utterly different issues. The combination of Medicaid and high-deductible insurance takes care of your first point. The second requires education of the consumers of heath care.

      • FriendlyGoat

        The bronze level of an ACA exchange policy IS a form of moderately-high-deductible insurance. As for educating consumers, that’s what my humble opinion was trying to do—-suggest that as many people who are willing not volunteer themselves to be over-treated.

  • Andrew Allison

    My primary care doctor does not get compensated for ordering unnecessary tests, which leads me to the conclusion that he orders them to protect himself from a malpractice suit. It’s reasonable to assume that, in general, tests performed by outside labs are, in fact, necessary, but for the wrong (CYA) reason. We should perhaps look to the trial bar as the primary cause of unnecessary testing. for example: my total cholesterol has been around 300 for the past 30 years and it has taken me several years to convince my current primary care physician (via imaging and EKG) that it’s not a problem and I don’t need statins with all their nasty side effects (he’s safe from the trail sharks, er bar because he recommended them and I declined). In short, it’s not the testing that’s the problem but what happens as a result.

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