That phalanx of laboratory tests can leave uninsured patients with painfully high medical bills for a routine cervical cancer screening, she said. The uninsured may also pay sticker prices for tests that insured patients receive for a discount.
“When I was in training, our attendings would ask a standard quiz question: “What is the biggest driver of healthcare costs in the hospital?” Answer: the physician's pen,” Bettigole wrote. “A mouse or a keyboard, rather than a pen, now drives the spending, but we physicians are responsible for ordering these unnecessary tests and hence responsible for the huge bills our patients are receiving.”
The costs, she stressed, are not merely financial. “The risk it poses, though—the one I face when a patient calls about a crippling bill—is that more and more women may choose not to undergo screening, afraid of the financial consequences.”
Laboratories market multiple tests that can be ordered simultaneously from a single specimen, she said. Meanwhile, electronic health records allow doctors to order a bundle of tests with the ease of clicking a mouse. “Nothing at any point along the way alerts either the clinician or the patient to the high costs of these tests or to the fact that there is little medical evidence to suggest that they are useful for most patients.”
She called for changes to empower and inform patients and doctors.
Patients need timely price information that can help them make decisions, she said. Physicians need more training to recognize the potential costs of ordering.
“As healthcare costs grow and laboratories develop savvy marketing tactics resembling those deployed by pharmaceutical companies, it is becoming increasingly clear that physicians have an obligation to be good stewards of limited resources and to understand the financial effects that the orders we write have on our patients,” she said.
The Affordable Care Act may help reduce patients' laboratory costs. Those previously uninsured who gain coverage under the expansion of Medicaid (when possible) or through subsidized private health plans will receive free Pap smears. That's because the 2010 healthcare reform law eliminated out-of-pocket costs from preventive care, said Sabrina Corlette, a research professor at the Georgetown University Health Policy Institute. But that may not protect patients from bills for additional tests bundled with the preventive screening, she said.
Follow Melanie Evans on Twitter: @MHmevans