In a recent article in the New York Times, (Medical Costs Rise as Retirees Winter in Florida, January 31, 2015) Elizabeth Rosenthal writes how excessive medical testing in Florida has led to a dramatic increase in health care costs and how much of the testing being done is unnecessary.
Increasingly, questions are being raised about the overtesting of older patients. That debate often centers on Florida, with its large percentage of retirees dependent on Medicare. There is a growing skepticism among healthcare professionals that many common tests, such as those for colon, breast and prostate cancer provide little benefit, and for patients with serious problems such as heart disease or dementia the tests pose serious health threats.
Medicare – the government insurance program for those over 65 or with disabilities – strictly regulates the price of tests and procedures. Rosenthal presents convincing evidence in her article that the price limits set by Medicare drive doctors to order more procedures, not out of necessity to the patient, but in an effort to generate more revenue by simply increasing volume.
A 2014 study done by Dartmouth University revealed that the number of tests and imaging studies received by Florida Medicare patients in the last two years of life, with the exception of the panhandle, totals were far above the national average. It isn’t because Florida has sicker patients, or better outcomes. Dr. Elliott Fisher, director of the Dartmouth Institute for Health Policy and Clinical Practice, says succinctly in the New York Times that, “It’s mostly based on how much doctors do in a system where you make more by doing more. Financial incentives and more entrepreneurial doctors are very important to what we’re seeing.”
The Evidence is compelling that patients in Florida; particularly the elderly are being overtested, overtreated, and overdiagnosed. Wasteful medical care is being driven by profits to test for mild or nonexistent problems. Too often these tests trigger a cascade of expensive, anxiety-producing diagnostic procedures and invasive treatments for slow-growing diseases that may never cause problems, leaving patients worse off than if they had never been tested.
One clear example has been routine PSA screening. Many doctors still order annual PSA tests for men of a certain age. But research has proven that routine PSA test for prostate cancer doesn’t save lives, but often triggers invasive interventions that cause painful complications. The AMA recommends the test not be done at all unless a man has a family history or special risk factors. Screening is usually too late too late to stop fast spreading tumors and too good at identifying slow growing tumors that would be better left alone.
CT scans are another prime example. In 1980, only about 3 million CT scans were performed in the United States. By 2013, that number had skyrocketed to 76 million. Because of this exposure to radiation has risen considerably. In CT scans—which typically emit far higher doses of radiation than traditional X-rays or even other imaging tests like mammograms. This radiation can damage cells’ DNA, which may, over time, lead to cancer.
In 2009, National Cancer Institute researchers estimated that the 72 million CT scansperformed in 2007 could lead to as many as 29,000 future cases of cancer. The Institute of Medicine has also concluded that one factor that is strongly associated with the risk of developing breast cancer is the ionizing radiation used in CT scans. A 2012 study by the Harvard School of Public Health shook the cancer industry when it published research showing that mammograms may not only be inappropriate for breast cancer screening, but may actually contribute to significant overdiagnosis of cancer that otherwise would have remained harmless.
In Florida PSA tests and CT scans are just two of the myriad of routine tests still prescribed regularly for the elderly. And researchers are questioning why?
There are many factors involved; patients who believe excessive care is the best care and request testing, incentives that pay doctors and hospitals for individual procedures, physicians’ fears of missing something important or of upsetting patients – but evidence continues to mount that often these routine tests are driven by one overriding factor – profit.
The Institute of Medicine estimates that an estimated $700 billion of unnecessary spending per year is being preformed in medical tests and that approximately 30 percent of all testing is unneeded.
Ultimately, Patients should have a trusting partnership with their doctor and feel comfortable asking hard questions and speaking up to make sure they get the right medical care—and avoid unnecessary tests and treatments. But when doctors in Florida are increasingly making decisions with an eye towards profit rather than long-term care, it remains to be seen how trusting that relationship can be.