Study suggests repeat testing common among Medicare beneficiaries

November 19, 2012

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

Repeat examinations are a "major determinant" of a physician's capacity to care for new patients and of the ability to contain health care costs, 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 longitudinal study of a 5 percent random sample of Medicare beneficiaries. 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 diagnostic tests 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 Medicare 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 stress tests were repeated within three years, as were 49 percent of pulmonary function tests, 46 percent of chest computed tomography, 41 percent of cystoscopies (an examination of the bladder), and 35 percent of upper endoscopies (examination of the digestive tract).

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.

(Arch Intern Med. Published online November 19, 2012. doi:10.1001/2013.jamainternmed.727.)

Editor's Note: Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.

Commentary: Failure to Curb Excess Testing

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. (Arch Intern Med. Published online November 19, 2012. doi:10.1001/.jamainternmed.2013.1780.)

Editor's Note: Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.
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To contact H. Gilbert Welch, M.D., M.P.H., call Annmarie Christensen at 603-653-0897 or email annmarie.christensen@dartmouth.edu. To contact corresponding commentary author Arnold Milstein, M.D., M.P.H., call Margarita Gallardo at 650-723-7897 or email mjgallardo@stanford.edu.

The JAMA Network Journals

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