More on the Cost of Needless Medical Tests

I commented last week on the tremendous cost of defensive medicine and the number of needless tests that are being performed by physicians simply as a "CYA" step in today's litigious climate. But according to Dr. Howard Brody, a professor of family medicine and Director of the Institute for the Medical Humanities at the University of Texas Medical Branch in Galveston, the motivations behind these unnecessary tests go well beyond just the fear of being sued.

He blames it on the combination of a love for technology and the current reimbursement system that pays more for using this technology (doing a procedure) than sitting with the patient and using his or her brain to figure out what is wrong. On his second point I need to agree completely. I have written in previous posts about our need to change the current fee for service system of reimbursement. Its bad enough that physicians and hospitals are still paid more in many circumstances for doing procedures, but there are also profitable versus unprofitable procedures. Physicians and hospitals have monetary incentives to aggressively pursue or perhaps withhold certain procedures. For physicians, a specialist who performs a significant number of invasive procedures will earn five to ten times more than the primary care physician who spends time with his or her patients to really figure out what is going on.

Often times complex procedures are completely necessary and life saving, but why have a system that puts financial rewards in possible conflict with appropriate medical care? Our fee for service reimbursement system has encouraged the development and use of tremendous technological breakthroughs, but I think it is time to swing the pendulum back a bit to reimburse physicians for the time they spend with their patients and use of their clinical judgement.

Dr. Brody chastises physicians and says there is a lack of moral leadership. He claims that they are acting just like one more special interest group in it only for themselves. I think this is a bit harsh. The fear of being sued is clearly a driving factor in many unnecessary tests. But reforming the reimbursement system for hospitals and specialists allowing medical judgements for care provided to be based solely on medical reasons and paying physicians for their time, would allow for a better level of care at ultimately less cost.

More on this later.

Mark Brodeur