Do I Really Need That? Patients Wary of Conflicts of Interest in Healthcare

U.S. healthcare spending is on the rise and shows no signs of slowing down. In 2017, spending grew 3.9% from the previous year, reaching $3.5 trillion. That’s roughly $10,739 per person in a single year. However, much of that spending may not be medically necessary. Providers are typically paid for each test and procedure they perform, which can lead to a conflict of interest, especially when patients have to foot the bill.

New studies reveal just how widespread medically unnecessary care can be, forcing patients to pay for procedures and tests they may not need. Find out why medically unnecessary care is on the rise and what patients can do to protect themselves.

Do Patients Really Need These Tests and Procedures?

Some tests and procedures are performed more often than they need to be. Many women get tested for cervical cancer every year, but healthcare providers recommend getting tested every three to five years instead. This is just one example of how medically unnecessary care can easily spiral out of control.

The cost of all those unnecessary procedures and tests can put an undue burden on consumers and families across the country. As a result, the healthcare community has come out with a list of 47 tests or services that have been flagged as overused or unnecessary, including cervical cancer screenings, lab tests, and heart evaluations.

With U.S. healthcare spending on the rise, the Washington Health Alliance, a non-profit group that wants to make care safer and more affordable, went looking for answers. To learn more about the rate of medically unnecessary care, the group sorted through insurance claims from 1.3 million patients in Washington state, all of whom received at least one of these often-unnecessary 47 tests or services. The findings were astonishing.

  • Over 600,000 patients in the state received care they didn’t need, resulting in $282 million in added costs.
  • 3 in 4 women received medically unnecessary cervical cancer screenings.
  • 85% of the lab tests used to prep healthy patients for surgery were found to be medically unnecessary.
  • Annual heart tests were performed on low-risk patients, resulting in $40 million in added costs.

Furthermore, the non-profit group ProPublica spent a year diving into this issue with a series of articles on how providers can overcharge for common procedures while recommending procedures and tests that their patients don’t need. Some examples include:

  • A mother took her five-year-old daughter in for a simple procedure, but, during a pre-operative visit, the doctor recommended piercing the girl’s ears as well. The mother was surprised but eventually went along with the doctor’s suggestion, resulting in a $1,877 bill for “operating room services.”
  • In another story, ProPublica analyzed how often nursing home drugs end up in the trash. These drugs are often delivered once a month, and nursing homes must dispose of all unused drugs if the patient dies or moves away. The Environmental Protection Agency estimated in 2015 that about 740 tons of drugs are wasted by nursing homes each year.
  • ProPublica also put the spotlight on drug manufacturers, including those that make eye drops for glaucoma patients. Eye drops can cost several hundred dollars per bottle. However, these doses contain too much liquid. Fluid will usually run down the side of the patient’s face, forcing them to pay for medicine they don’t even use.
  • Overall, this added waste results in $765 billion a year in medically unnecessary care, according to the National Academy of Medicine.

Why Is Medically Unnecessary Care So Common?

Getting to the heart of the problem of medically unnecessary care can be complicated. We live in a healthcare system that pays providers for each test and procedure they perform, which can give some providers an incentive to overprescribe certain tests and procedures.

But it’s not just providers. Prescription drug manufacturers can also contribute to the problem by creating drugs that often go to waste. Facility administrators may also put pressure on individual providers to recommend these tests and procedures, especially if the facility is struggling to make ends meet.

Misinformation can also be part of the problem. Patients and providers alike may get their information from unreliable sources, leading to the overuse of certain procedures and tests.

Rethinking the Phrase “Do No Harm”

Doctors have a responsibility to follow the oath, “Do no harm.” Recommending medically unnecessary tests and procedures to patients may not affect their health, but it can drain their finances. Millions of Americans are struggling to pay their healthcare bills. The average U.S. consumer spends more than $10,000 a year on healthcare. According to the New York Times, Americans borrowed $88 billion to pay for healthcare in 2018 alone.

If providers take into consideration the financial toll these medically unnecessary procedures and tests can have on their patients, the phrase “do no harm” easily applies.

How Patients Can Protect Themselves

Patients depend on the expertise and advice of their healthcare providers, but they might want to ask a few questions along the way to make sure their provider has their best interest at heart.

Here are a few questions to keep in mind:

  1. Is the test or procedure medically necessary?
  2. What are the consequences if I don’t get the test or procedure?
  3. How much does the test or procedure cost?
  4. What is the billing code for this test or procedure?
  5. What is the provider’s National Provider Identifier and/or Tax ID number?
  6. Can you send me an itemized bill?
  7. Do you have a financial assistance program or policy?

Patients can use this information to make sure their provider and the test or procedure are covered by their insurance. To avoid being overcharged for care, patients should only see providers that are in-network. Patients should also send the billing code for the procedure and the provider’s Tax ID number to their insurance provider for more information.

Medically unnecessary care continues to be a drag on patients and the U.S. healthcare system as a whole. Patients should be able to trust individual care providers without worrying about how much these tests and procedures will cost. Providers should always have their patients’ best interests at heart, including how these tests and procedures will affect their patients’ finances.

Be on the lookout for medically unnecessary care to help your patients save money where it counts.

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