AIM: Annual bill for unnecessary tests reaches $6.7B

Researchers at Mount Sinai School of Medicine have analyzed the Top 5 overused clinical activities for primary care physicians and found that $6.7 billion was spent in one year performing unnecessary tests or prescribing unnecessary medications in primary care. Although imaging dominated the Top 5 list, the recommendations published online Oct. 1 in the Archives of Internal Medicine focused on curbing brand name statin prescriptions, which accounted for 86 percent of the cost.

The research team reviewed findings from a study published in the May 2011 of Archives of Internal Medicine, which identified the top five most overused clinical activities in each of three primary care specialties: pediatrics, internal medicine and family medicine.

With this information, they performed a cross-sectional analysis of separate data that were pulled from the National Ambulatory Medical Care Survey and the National Hospital Ambulatory Medical Care Survey. They found more than $6.7 billion was spent in excess healthcare spending in the primary care setting in 2009. More than $5.8 billion of the unnecessary spending resulted from the prescribing of brand-name statins rather than generic versions.

"Our analysis shows astronomical costs associated with prescribing of brand name statins when effective, generic alternatives were available. Efforts to encourage prescribing of generics clearly have not gone far enough," said  Minal S. Kale, MD, of Mount Sinai School of Medicine in New York City, in a statement. "Additionally, millions are spent on unnecessary blood work, scans and antibiotic prescriptions. Significant efforts to reduce this spending are required in order to stem these exorbitant activities."

The remaining costs were attributable to the following:

• During physical exams, more than half of complete blood work ordered was not needed, resulting in more than $32 million in excess costs.
• Unnecessary bone density scans in younger women accounted for more than $527 million.
• CT scans, MRIs or x-rays in people presenting with back pain accounted for $175 million in excess healthcare costs.
• Over-prescription of antibiotics for sore throat in children, excluding cases of strep throat or fever, accounted for $116 million in unnecessary costs.
• Other excess costs included needless annual echocardiograms, urine testing, pap tests and pediatric cough medicine prescriptions.

“Although generic drug substitutions may appear to be ‘low hanging fruit’ for drug savings, numerous efforts have already been made by the U.S. states (generic substitution laws), payors (tiered formularies) and healthcare providers (generic drug detailing) to achieve this goal,” wrote the authors. “In this light, our data suggest that considerably more work is needed to reduce the costs associated with brand name statin use.”

Kale and colleagues also noted that the scope of analysis should be wider than just primary care. “Expanding the methods of physician consensus to identify ‘high-value’ targets to specialties outside of primary care could bring us closer to achieving the goal of affordable and high-quality healthcare,” wrote the authors.

"We found considerable variability in the frequency of inappropriate care, however, our data show that even activities with small individual costs can contribute substantially to overall healthcare costs," they concluded. "In light of the current healthcare reform debate, we need more research examining how overuse contributes to healthcare spending. Research might focus on the potential role of reimbursement, defensive medicine practices or lack of adherence to guidelines."