Unnecessary Medical Treatment: Costly for Patients

A number that seems to be continuously growing is the amount of healthcare spending in the United States, which has reached $3.5 trillion. According to research and multiple studies, this amount is high due to unnecessary medical treatment. Also referred to as “low-value care,” unnecessary medical treatment occurs when the risk for harm outweighs the chance of benefit. Here’s an overview of recent statistics about unnecessary medical treatment:

• Surveyed U.S. physicians report that more than 20 percent of overall medical care is not needed, including 25 percent of tests, 22 percent of prescriptions and 11 percent of procedures.
• The Congressional Budget Office recently estimated up to 30 percent of the costs of medical care delivered in the U.S pays for tests, procedures, doctor visits, hospital stays and other services that may not actually improve patient health.
• Unnecessary medical treatment impacts the healthcare industry through decreased physician productivity, increased cost of medical care and additional work for front office staff and other healthcare professionals.

The reasons most often given by physicians for overtreatment are fear of malpractice, patient pressure/request and difficulty accessing medical records. Considering malpractice is cited as the biggest reason physicians overtreat, a mere 2-3 percent of patients harmed by medical negligence sue, of which about half receive compensation. In spite of the statistics, 84.7 percent of physicians fear malpractice lawsuits because of the risks they can pose to their livelihood.

Patient Pain Points

Beyond being costly for the healthcare industry, unnecessary medical treatment can have negative consequences for patients affected by it. For example, prescription drugs prescribed unnecessarily may have adverse effects. Patients who receive imaging without a detailed reason may be exposed to excessive radiation, which can increase their risk of disease.

Over-imaging in low-risk populations can detect abnormalities that are benign, return false positives and heighten a patient’s anxiety. While screenings may extend and improve lives for healthy, young adults, they can inadvertently cause stress when proven unnecessary. Patients who have undergone unnecessary medical treatment have experienced medical and financial anxiety, scheduling concerns and additional health problems.

Preventing Patient Harm

Research has shown that overtreatment is directly associated with preventable patient harm and represents a significant opportunity to improve patient safety.

One major initiative created to address unnecessarily medical treatment or low-value care is Choosing Wisely, an initiative of the American Board of Internal Medicine ABIM Foundation. One of the campaign’s resources from national organizations representing medical specialists, is a list stating “tests or procedures commonly used in their field whose necessity should be questioned and discussed.” The campaign also recommends patients ask their physicians these five basic questions before they undergo any test or treatment:

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?

A survey of physicians recommends solutions to help training medical residents to better understand the criteria for appropriate care. These include making outside medical records easier for physicians to access and developing more evidence-based guidelines for physicians to follow in their practices. Other ways to reduce unnecessary tests and procedures include continuing education for healthcare professionals, regularly updated patient records and improved doctor/patient communication.

At Advanced Medical Reviews, we believe every patient should receive quality healthcare. We determine medical necessity in our reviews by applying evidence-based guidelines and medical literature and utilizing our strong quality assurance process to guarantee the highest quality standards throughout the review process. We are able to offer recommendations regarding the necessity of care based on our extensive knowledge of the healthcare industry. Plus, provide unbiased decisions and eliminate conflicts of interest, making healthcare safer and more affordable for every U.S. resident.

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