Too many Americans undergo ‘low value’ medical tests and procedures

News Image: Too many Americans are having 'low value' medical tests and procedures

WEDNESDAY, February 23, 2022 (HealthDay News)

When your cardiologist orders a test, do you stop to wonder why you need it? You probably don’t — but maybe you should, according to a new report from the American Heart Association (AHA).

Too many Americans are receiving heart tests and treatments that do little good, and more needs to be done about it, according to the AHA.

The issue of “low-value” medical care is an old one — with about half of Americans receiving at least one such test or procedure each year, the cardiac association notes.

The term refers to health care services that are unlikely to benefit patients significantly, exposing them to potential harm and wasted money. Low-value medical care is estimated to account for approximately 30% of health care spending in the United States, or up to $101 billion annually.

in a new scientific statementthe AHA is bringing renewed attention to the issue, particularly as it relates to cardiac care.

Low-value tests and treatments include stress testing for people who have had angioplasty or surgery to clear clogged arteries; echocardiograms to assess people who have passed out but have no signs or symptoms of heart problems; and coronary calcium tests for people already known to have heart disease.

“Clinicians and systems really strive to provide the best patient care,” said Dr. Vinay Kini, chair of the AHA’s statement writing group.

But for a variety of reasons, he said, some low-value practices may become or remain mainstream.

As new technologies and treatments quickly become available, Kini said, medical professionals need to figure out how best to use them. And some uses may outpace the evidence.

Modification of “best practices”

There may be a practice that 15 years ago seemed like the wisest course, Kini said, but evidence gathered since shows otherwise.

And once a practice is established, it can be difficult to recall it, said Dr. Richard Kovacs, chief medical officer at the American College of Cardiology (ACC).

Individual physicians can rely on their personal experience and belief that a test or treatment helps patients and stick to it. Or, Kovacs said, they may simply be unaware of the evidence that a given practice is in fact of low value.

Then there’s the fear of being sued, he noted, which can prompt doctors to practice “defensive medicine” and order tests to make sure nothing was missed.

“And we have to be upfront,” Kovacs said. “Some doctors do it for financial reasons.”

Since 2006, the ACC has published “appropriate use criteria” for many cardiac tests and procedures, in an effort to limit low-value care.

“I think they changed the practice and changed it for the better,” said Kovacs, who was not involved in the new report.

But there’s still plenty of room for improvement, according to Kini.

An example is the cardiac stress test, where people walk on a treadmill or pedal a stationary bike while monitoring their heart rate, blood pressure and breathing.

Research suggests that up to half of stress tests performed in the United States would be considered “rarely appropriate,” according to the AHA. The problem with this isn’t just the wasted time and money: it can also lead to invasive testing that carries more risk and even more expense.

It’s not that the heart tests themselves are useless. They must be applied to the right patient, says the AHA.

Take coronary calcium tests, for example. The non-invasive tests detect calcium deposits in the arteries and can be “of great value” when a patient is considered to be at “intermediate” risk of heart attack. If the calcium score is high, it is advisable to start cholesterol-lowering treatment. statin medication.

The test, however, is of no value for someone with known blockages in the heart’s arteries: a statin would clearly be appropriate.


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What can be done? Actions at different levels are needed, Kini said.

On a general level, the US healthcare system is designed to reward quantity – more tests, more treatments – over quality. A payment system based on quality of care is the “way forward,” Kini said, although defining quality is complicated.

And one downside, he noted, is that these systems can end up punishing safety-net hospitals, which serve low-income patients whose circumstances — including poverty and unstable housing — can make their care much more complicated. It will therefore be necessary to ensure that alternative payment systems do not aggravate inequalities in health care.

What Patients Can Do

Patients also play a role, Kini and Kovacs said. In some cases, they demand tests or treatments that are not necessary, and their provider refrains.

That doesn’t mean patients should keep quiet, though. It’s the opposite, Kovacs said: If your doctor recommends a test or treatment, don’t hesitate to ask why and if there are any alternatives.

“I would greet my patients by saying, ‘What are my options? ‘” Kovacs said.

And while costs are a huge issue for the healthcare system, they also matter for patients, Kini pointed out. With the rise of high-deductible insurance plans and other forms of “cost sharing,” American patients are bearing a greater share of their medical bills.

That makes it even more important, Kini said, to ensure they receive high-value care.

The statement was published February 22 in the journal AHA Circulation: quality and cardiovascular results.

More information

Choose wisely has more on cardiac tests and procedures.

SOURCES: Vinay Kini, MD, MSHP, assistant professor, medicine, Weill Cornell Medical College, New York; Richard Kovacs, MD, chief medical officer, American College of Cardiology, Washington, DC; Circulation: quality and cardiovascular resultsFebruary 22, 2022, online

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