Study suggests repeat testing common among medicare beneficiaries

November 19, 2012, JAMA and Archives Journals

A study suggests that diagnostic tests are frequently repeated among Medicare beneficiaries, according to a report published Online First by Archives of Internal Medicine.

Repeat examinations are a "major determinant" of a physician's capacity to care for new patients and of the ability to contain , the authors write in the study background.

H. Gilbert Welch, M.D., M.P.H., of Dartmouth College, Hanover, N.H., and colleagues examined patterns of repeat testing in a of a 5 percent random sample of . They also studied the relationship between the proportion of the population tested and the proportion of tests repeated among those tested using the 50 largest metropolitan statistical areas as the unit of analysis.

"We examined repetitive testing for six commonly performed in which repeat testing is not routinely anticipated. Although we expected a certain fraction of examinations to be repeated, we were struck by the magnitude of that fraction: one-third to one-half of these tests are repeated within a three-year period. This finding raises the question whether some physicians are routinely repeating diagnostic tests," the authors note.

The study results indicate that among beneficiaries undergoing echocardiography (examination of the heart), 55 percent had a second test within three years. Repeat testing for the other examinations also was common: 44 percent of imaging were repeated within three years, as were 49 percent of , 46 percent of chest computed tomography, 41 percent of cystoscopies (an examination of the bladder), and 35 percent of upper endoscopies (examination of the ).

The proportion of the population tested and the proportion of tests repeated also varied across metropolitan statistical areas, according to the results.

"In conclusion, diagnostic tests are frequently repeated among Medicare beneficiaries. This has important implications not only for the capacity to serve new patients and the ability to contain costs but also for the health of the population. Although the tests themselves pose little risk, repeat testing is a major risk factor for incidental detection and overdiagnosis. Our findings should foster further research in this unstudied area," the authors conclude.

In an accompanying commentary, Jerome P. Kassirer, M.D., of Tufts University School of Medicine, Boston, and Arnold Milstein, M.D., M.P.H., of Stanford University School of Medicine, Palo Alto, Calif., write: "After decades of attention to unsustainable growth in health spending and its degradation of worker wages, employer economic vitality, state educational funding and fiscal integrity, it is discouraging to contemplate the fresh evidence by Welch et al of our failure to curb waste of health care resources."

"To avoid reading an almost identical article about unwarranted geographic variations in these pages 10 years from now, physicians will need to support expansion of peer-designed active electronic clinical guidance systems and faster retirement of fee-for-service incentives," they continue.

"No matter what future payment system is implemented, some intercession in clinical decision making will be required to protect patients from too many tests and from too few tests. We have not come close to getting it right," they conclude.

Explore further: Financial reimbursement increases cardiac stress tests

More information: Arch Intern Med. Published online November 19, 2012. doi:10.1001/2013.jamainternmed.727
Arch Intern Med. Published online November 19, 2012. doi:10.1001/.jamainternmed.2013.1780

Related Stories

Financial reimbursement increases cardiac stress tests

November 8, 2011
Patients treated by physicians who billed for both technical (practice/equipment) and professional (supervision/ interpretation) components of nuclear and echocardiographic stress imaging tests were more likely to undergo ...

Electronic test result access does not reduce test ordering

March 6, 2012
(HealthDay) -- For office-based physicians, electronic access to patient imaging and laboratory test results does not decrease -- and may actually increase -- the number of diagnostic tests ordered, according to research ...

Higher levels of primary care physicians in area associated with favorable outcomes for patients

May 24, 2011
Medicare beneficiaries residing in areas with higher levels of primary care physicians per population have modestly lower death rates and fewer preventable hospitalizations, according to a study in the May 25 issue of JAMA.

Study examines medicare use for Mohs micrographic surgery and surgical excision for skin cancer

April 16, 2012
An analysis of Medicare beneficiaries suggests that surgical treatment for nonmelanoma skin cancer (NMSC) increased substantially from 2001 through 2006, primarily due to a doubling in the rate of Mohs micrographic surgery ...

Recommended for you

Wine is good for you—to a point

January 18, 2018
The Mediterranean diet has become synonymous with healthy eating, but there's one thing in it that stands out: It's cool to drink wine.

Sleep better, lose weight?

January 17, 2018
(HealthDay)—Sleeplessness could cost you when it's time to stand on your bathroom scale, a new British study suggests.

Who uses phone apps to track sleep habits? Mostly the healthy and wealthy in US

January 16, 2018
The profile of most Americans who use popular mobile phone apps that track sleep habits is that they are relatively affluent, claim to eat well, and say they are in good health, even if some of them tend to smoke.

Improvements in mortality rates are slowed by rise in obesity in the United States

January 15, 2018
With countless medical advances and efforts to curb smoking, one might expect that life expectancy in the United States would improve. Yet according to recent studies, there's been a reduction in the rate of improvement in ...

Teens likely to crave junk food after watching TV ads

January 15, 2018
Teenagers who watch more than three hours of commercial TV a day are more likely to eat hundreds of extra junk food snacks, according to a report by Cancer Research UK.

Can muesli help against arthritis?

January 15, 2018
It is well known that healthy eating increases a general sense of wellbeing. Researchers at Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU) have now discovered that a fibre-rich diet can have a positive influence ...

0 comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.