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Billions in Unnecessary Medical Treatment – and We All Pay the Cost

Early last year on the AgingOptions blog we wrote about the staggering cost of wasted medical care and unnecessary tests. It’s a cost that weighs down our over-burdened health care system and drains away billions of medical dollars each year. Many experts suggest that seniors are disproportionately affected by these unnecessary and often harmful tests, causing needless expense, worry, discomfort and even dangerous side effects.

One recent incident that we know about brought this issue to mind – in a good way. A 67 year old man of our acquaintance was told by his cardiologist that it was time for a treadmill test, also called a stress echocardiogram. But the day before the test, this man (who has no symptoms of heart disease) got a call from his doctor that the insurance company had denied coverage for the “stress echo” because they deemed this test medically unnecessary. Maybe some companies are starting to get the message, and if so it’s about time.

Every so often in our research we discover articles and studies that we find deeply frustrating. Here’s another example, from the website NextAvenue: an article that’s titled, “Are You Getting Medical Treatment You Don’t Need?”  If you are – and chances are good that you or someone you love has received needless medical treatment – you’re probably paying through the nose and didn’t even realize it.

The 2017 article in Next Avenue was written by contributor Lois Rudick Hall. She writes that medical care already places a significant financial burden on patients, thanks to co-pays, hefty deductibles, and various other out of pocket costs. But often the real culprit often lies hidden behind the scenes in the form of tests and procedures that have been shown to be useless, even harmful. Hall quotes what she calls an “unnerving fact: Many of the services that patients receive are duplicative, unnecessary and actually have no value or a negative value to our health.”  Yet tragically these tests and procedures continue to be conducted, resulting in stress, pain, discomfort, side-effects, lost productivity and major inconvenience.

(Although the NextAvenue article appeared last year, this article we just discovered on the Salon website makes it clear that waste is alive and well. Salon quotes a ProPublica study that tells how much money is being squandered. “The waste is widespread,” says Salon, “estimated at $765 billion a year by the National Academy of Medicine, about a fourth of all the money spent each year on health care.”)

The Next Avenue story contains several links to other articles and studies that prove Hall’s point. One link took us to this 2014 article in Forbes magazine that looked at a study of Medicare patients, published in JAMA (also known as the Journal of the American Medical Association). The JAMA study investigated a list of 26 medical tests or procedures that medical experts have deemed unnecessary, and concluded that every single Medicare patient receives, on average, one of these needless procedures every year. A few examples: JAMA says inserting stents into the arteries of patients with stable heart disease led to $3 billion in annual waste. Performing cardiac stress tests (like the one our 67 year old friend was scheduled to have) on patients with stable heart disease accounted for another $2 billion in squandered dollars.  Unnecessary imaging for back pain ($200 million) and headaches (another $200 million) added to the total.  In short, researchers in 2014 estimated these 26 tests alone accounted for $8 billion in wasted Medicare spending.

If you want to put this problem in a broader societal perspective, consider this: the Institute of Medicine published a study in 2012 asserting that fully one-third of U.S. medical spending did nothing to make anyone healthier. That was $750 billion out of total spending of $2.6 trillion! And in the words of the study, at least $200 billion of that amounted to services the IOM classified as completely unnecessary. This confirms the findings in the Salon article.

So what are we to do to protect ourselves and our loved ones from procedures that are costly, painful, and unnecessary? The first line of defense, writes Lois Hall, is to ask questions.  Because we may typically lack the information to make an informed decision about the benefit of tests or services our physician suggests, “we too often forge ahead with our physician’s recommendations because we feel worried or rushed. Asking questions may make us feel uncomfortable — and we may not even know what questions to ask.” But asking questions is critically important.  Your doctor may be well-intentioned but ill-informed, or he or she may be practicing what is called “defensive medicine,” prescribing tests as a means of self-protection. Sometimes a doctor may have financial incentives for steering patients to a particular facility for services. You have to protect yourself by thinking like a consumer.

To better equip yourself next time your doctor recommends a test you think might be inappropriate or wasteful, NextAvenue  offers these “Five Questions to Ask Your Practitioner,” originally published in Consumer Reports:

  1. Do I really need this test or procedure?
  2. What are the risks and side effects?
  3. Are there simpler, safer options?
  4. What happens if I don’t do anything?
  5. How much does it cost, and will my insurance pay for it? (Or how much will it cost me?)

The NextAvenue article contains several other helpful links which we encourage you to investigate, and it concludes with a few final points. First, if you feel your doctor is rushing things, unless it’s a matter of immediate life or death, get a second opinion from someone who isn’t associated with the first provider. Second, don’t go to the appointment alone: bring a friend or loved one along to ask questions and take notes. Finally, if your doctor becomes defensive or evasive in response to your questions, consider finding another provider. Evasiveness or defensiveness is a red flag.

This issue of medical waste and unnecessary tests and procedures is one more reason why we urge seniors to visit a geriatric physician, or geriatrician, for their primary care. A geriatrician understands the complex needs of the aging adult. He or she will never rush you into treatment that’s wrong for you, but instead will listen, evaluate objectively, and help you and your family make an informed decision. Your geriatrician will act as your health care advocate if you ever need hospitalization or other urgent care. Contact us here at AgingOptions and we will gladly recommend a geriatrician in your area.

Chances are we’ll also be coming to your area soon with one of our highly popular LifePlanning Seminars. Wouldn’t you love to have a retirement plan that brings all the “puzzle pieces” of retirement together into one clear picture? A LifePlan does just that, weaving your financial, legal, housing, medical and family plans all together in an integrated whole. It’s easy to find out more simply by attending a free LifePlanning Seminar soon. You’ll be very glad you did!

Click here for dates, times, locations and online registration. Or if you prefer, give us a call during the week, and we’ll be more than happy to assist you.

(originally reported at www.nextavenue.org)

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