Appropriate Use of Screening and Diagnostic Tests to Foster High-Value, Cost-Conscious Care

Abstract

Unsustainable rising health care costs in the United States have made reducing costs while maintaining high-quality health care a national priority. The overuse of some screening and diagnostic tests is an important component of unnecessary health care costs. More judicious use of such tests will improve quality and reflect responsible awareness of costs. Efforts to control expenditures should focus not only on benefits, harms, and costs but on the value of diagnostic tests-meaning an assessment of whether a test provides health benefits that are worth its costs or harms. To begin to identify ways that practicing clinicians can contribute to the delivery of high-value, cost-conscious health care, the American College of Physicians convened a workgroup of physicians to identify, using a consensus-based process, common clinical situations in which screening and diagnostic tests are used in ways that do not reflect high-value care. The intent of this exercise is to promote thoughtful discussions about these tests and other health care interventions to promote high-value, cost-conscious care.

Inappropriateness in laboratory medicine: an elephant in the room?

“…Another important aspect is that the final cost of a given laboratory test not only includes the direct cost of the assay, but also downstream expenditure which can be triggered by test results (22). It is now undeniable that the larger the number of tests ordered, the greater the chance of generating both false positive or false negative results, which may then promote follow-up, often invasive and expensive investigations, which in turn can have a serious impact on patients safety.…”

Physician Cost Consciousness and Use of Low-Value Clinical Services

“…2,3 As opposed to rationing, where available services are restricted despite potential benefits, limiting low-value services promotes avoidance of wasteful, unnecessary testing and treatment. 4 Specialty groups participating in the Choosing Wisely TM Campaign created "top 5 lists", including primary care.…”

Another Pill, Another Test, and Another Procedure: One Resident's Reflection on Healthcare Cost Containment

“…1,3 Although there are numerous causes for this problem, many argue that wasteful and possibly harmful overuse of medical services is an integral factor. [1][2][3][4][5][6][7][8] In fact, overuse has been shown to contribute to 30% of healthcare expenditures, while focusing on the reduction of wasteful medical services in highexpenditure areas has lowered the overall cost of healthcare by 20% in those regions. 4,7 For example, Sirovich et al showed that 47% of physicians in highspending regions schedule hypertensive patients at least every 3 months, while only 19% of physicians in low-spending regions schedule such frequent followup visits, with no difference in quality of care or symptom improvement.…”