When Rhetoric Doesn’t Match Reality – Why Claims of Overutilization Ignore the Real Dollar Signs
Today, decades of medical progress have contributed to a sea change in how we treat the most serious and complex health issues. We’ve seen ground-breaking innovations that allow us to identify diseases like cancer and HIV-AIDS and intervene with targeted, comprehensive care plans. Laboratory tests are the starting point for this next generation of care delivery.
While much attention has been paid to the overuse of certain medical services, often little attention is paid to how the underuse of services leads to increased personal and financial costs –by causing patients to delay or forego medically necessary care. Too often patients skip routine tests or regular health assessments, leading to health conditions that become progressively worse when left untreated.
Not surprisingly research has consistently pointed to inappropriate use as one of the primary cost drivers across the health system. While overuse is a component of inappropriate use, recent studies show that underuse has a more significant effect. In either case, we should be focused on appropriate use, running the right test, on the right person, at the right time. So how do we differentiate between the two? It starts by separating the rhetoric from reality and putting dollars signs into context.
FACT: SPENDING ON LABORATORY TESTS ACCOUNT FOR A SMALL PERCENTAGE—ABOUT 2%—OF MEDICAL COSTS IN THE U.S.
When it comes to addressing the major cost drivers across the health system, laboratory tests are at the very bottom of the list. In total, spending on laboratory tests and diagnostics account for roughly 2% of the country’s medical spend, yet deliver the best value for patients and employers’ health care dollars.
FACT: UNDERUSE OF PREVENTATIVE TESTING AND TREATMENT IS ONE OF THE LEADING FACTORS CONTRIBUTING TO PROGRESSIVELY COMPLEX, COSTLY HEALTH CONDITIONS.
Despite our ability to provide life-saving care, research points to a growing percentage of Americans who are missing critical inflection points because they aren’t getting the tests they need. Case in point—According to key reports:
- Only 24% of individuals with diabetes received the appropriate number of hemoglobin tests, even though these tests are critical in reducing diabetes complications such as blindness, amputation, and kidney failure.
- Roughly 38% of adults received colorectal cancer screening, despite the fact that annual fecal occult blood tests and stool samples could prevent about thousands of deaths each year.
- Barely 16% of toddlers at high risk for sepsis received urine tests, even though such tests can help prevent recurrent infections, renal damage, and chronic renal failure.
Further, when it comes to preventative care, a 2012 analysis from the Centers for Disease Control and Prevention (CDC) found that that tens of millions of Americans are likely missing out on these essential services—including HIV tests, colorectal screening, and diabetes care. The same CDC report found that only 68% of eligible patients reported that they had been screened during the previous 5 years—even though screening helps avoid cardiovascular disease, one of the expensive conditions treated in U.S. hospitals. Underuse of laboratory tests and services not only adds to the systemic costs to the system, but contributes to long-term health care expenses for patients and families.
FACT: LABORATORY TESTS ARE THE FIRST STEP FOR DIAGNOSING, TREATING AND MANAGING DISEASE.
Clinical laboratory tests play a fundamental role in improving appropriate utilization across the health system. With the information provided by lab tests, doctors have the ability to help:
- Diagnose a heart attack: By testing for cardiac enzyme markers, physicians can tell whether a patient’s chest pains signal a heart attack or something less serious. Some $12 billion is spent annually on inappropriately hospitalizing patients who are not actually experiencing heart attacks.
- Treat breast cancer: By identifying the precise molecular nature of a patient’s tumor, physicians can select the most effective cancer drug or, in the case of many patients, help them avoid chemotherapy that will not be needed. This saves hundreds of millions of dollars per year in addition to sparing patients the debilitating side effects of chemotherapy.
- Slow the progression of kidney disease: By using the eGFR test, physicians can help delay and sometimes prevent kidney failure, which can cost $80,000 annually per person
- Manage diabetes: By performing glucose tests, physicians can prescribe care that helps patients avoid diabetes and its complications—heart attack ($28K), amputation ($27K), and peripheral artery disease ($6K per year).
FACT: PHYSICIANS AND PROVIDERS USE LAB TEST RESULTS AS ONE FACTOR TO INFORM THE TREATMENT PLANS OF THEIR PATIENTS
Physicians and other health care providers evaluate patients’ health and are responsible for making clinical decisions around care, including whether to complete certain tests. In most cases, laboratory professionals do not engage with patients, providing results directly to the patients’ physician. The laboratory relies on the best medical judgment of the physician to determine the appropriate use for a laboratory test.
One way to ensure that providers are delivering the best, most appropriate care for patients is to ensure that care delivery and treatment plans align with evidence-based clinical guidelines from leading medical societies and public health experts.