NCPA - National Center for Policy Analysis

Repeat Testing Common among Medicare Patients

November 21, 2012

In a new study, up to half or more of adults on Medicare who had a heart, lung, stomach or bladder test had the same procedure repeated within three years, says Reuters.

  • Those tests typically aren't supposed to be routinely repeated, researchers said.
  • For some of them, such as echocardiography and stress tests for heart function, there are recommendations specifically against routine testing.

Extra testing can burden the health care system with costs and may lead to incidental findings and unnecessary treatment for patients, says Dr. H. Gilbert Welch, lead author of the report from the Dartmouth Institute for Health Policy and Clinical Practice in Hanover, New Hampshire.

  • He and his colleagues looked at the use of six kinds of test -- echocardiography (ultrasound of the heart), stress tests, lung function tests, chest CT scan, cystoscopy (examination of the bladder with a scope) and upper endoscopy (examination of the upper GI tract) -- among 743,478 older adults with fee-for-service Medicare coverage.
  • All of those tests are diagnostic, meaning they would typically be done on people with symptoms to help doctors make a diagnosis.
  • They range in price from about $200 to over $1,000.
  • Between 2004 and 2006, anywhere from 7 percent (cystoscopy) to 29 percent (echocardiography) of the Medicare beneficiaries in the study had each of those tests at least once.

And those exams were all commonly repeated:

  • Thirty-five percent of the people who had an upper endoscopy had another within three years.
  • Of those who had an echocardiogram, 55 percent had a repeat echocardiogram.
  • Repeat rates for the other tests fell somewhere in between.
  • The average time between multiple tests was anywhere from four to 14 months.

Welch says the only time repeat tests make good medical sense is when patients develop a new set of symptoms that doctors want to check out after the first test. But for physicians, financial incentives typically support more frequent testing, no matter what the purpose. His team also found that metropolitan areas that did more of the initial diagnostic tests to begin with also had higher rates of retesting.

Source: Genevra Pittman, "Repeat Testing Common among Medicare Patients," Reuters, November 19, 2012.


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