A great many tests, prescriptions and procedures offer nothing but costs. The healthcare industry generously calls them “low-value services”. In reality they are no-value services. I call them waste and we are riddled with them.
More than 2,000 surveyed physicians stated that about a quarter of all tests, more than a fifth of prescriptions, and more than a tenth of procedures are not needed. A whopping seventy-two percent of physicians admitted to prescribing a needless test or procedure at least once a week and that more than 20% of all medical care rendered were not needed. That’s a lot of waste!
Ten years ago, the American Board of Internal Medicine (ABIM) created the Choosing Wisely program. They asked 93 specialists to identify tests or procedures that they commonly do that were not evidence-based, not duplicates of tests already done, not truly necessary and not free from harm. In other words, what can be safely scrapped? They came up with 626 procedures.
Those procedures are still being done. The Lown Institute estimates that each year, low-value services are offered to 11% of commercially insured patients, 15% of Medicaid and 40% of Medicare patients . They cost us hundreds of billions dollars yearly.
In ten months, Medicare patients received 106, 474 low-value services. Almost half, 45,176 went for coronary artery stents on patients with stable coronary disease who could have been managed just as effectively with medication. We’ve known that fact for years.
Other no-value tests that you may recognize are:
Baseline pre-op lab tests, EKGs, chest x-rays and pulmonary function tests for low risk patients having low risk surgery.
Yearly EKGs or other cardiac screening for low-risk asymptomatic patients
Routine head CT scans for ED visits for severe dizziness,
Imaging for low-back pain within the first six weeks of pain without red flags and imaging for uncomplicated acute rhino-sinusitis
Willy- nilly screening for vitamin D deficiency.
PSA-based prostate cancer screening in all men and yearly cervical cancer screening in women ages 21- 65
IHealthcare services account for 20%, or $900B, of the $4.5 trillion spent every year. We should be able to save $180B if we eliminated the waste..