Repeat testing common with Medicare patients: study

Doctors frequently repeat diagnostic tests on Medicare beneficiaries, and the tests are raising healthcare costs and hindering doctors' ability to care for new patients, according to a study in the Archives of Internal Medicine.

The study, which was led by Dr. Gilbert Welch, a professor of medicine at the Dartmouth Institute for Health Policy and Clinical Research, analyzed testing patterns for a random sample of 5% of Medicare patients, and also looked at the proportion of repeated tests in the 50 largest metropolitan areas.

The study found that even when researchers looked at tests that aren't routinely done more than once, one-third to one-half of tests were repeated within a three-year period.

In particular, the data showed that 55% of Medicare beneficiaries underwent a second echocardiography procedure within three years, 49% had repeat pulmonary function tests, 41% had repeat cystoscopies and 35% had repeat upper endoscopies.

It also found variations among metropolitan regions. Patients in Miami, for instance, underwent the highest number of repeat echocardiography, cystoscopy and upper endoscopy procedures. In contrast, patients in Portland, Ore., underwent the lowest number of repeat echocardiography, cystoscopy and imaging stress tests.

The authors of the study noted that the findings suggest that some physicians may be routinely repeating procedures. They added that while the tests themselves may carry little risk, they increase the possibility of incidental findings and overdiagnosis.

An accompanying editorial called the study findings “discouraging” and urged either electronic clinical guidance systems or a move away from fee-for-service payments as a way to protect patients from undergoing inappropriate tests and further driving up healthcare spending.