Minnesotans spent at least $55 million dollars on health services in 2014 that provide little or no benefit to patients but that may have the potential to cause harm, according to a report released Wednesday by the Minnesota Department of Health (MDH).
They spent $9.3 million of that amount themselves in out-of-pocket costs, the report also found.
The actual amount spent by Minnesotans each year on unnecessary medical procedures is undoubtedly much higher because the report looked at only 18 low-value health services.
That’s a small portion of the more than 450 overused or unnecessary medical tests and treatments have been identified by the Choosing Wisely campaign, launched in the United States in 2012 by the American Board of Internal Medicine Foundation and Consumer Reports.
And that campaign is far from completing its list of unnecessary procedures.
The MDH report, however, marks the first time researchers have taken a detailed look at low-value services specifically in Minnesota.
“This research identifies a significant area of wasted resources and unnecessary exposure to potential patient harm,” said Minnesota Health Commissioner Dr. Ed Ehlinger, in a released statement. “Providers and patients need to join together to avoid these tests that add needless expense to our overly expensive health care system.”
Collecting the data
For the study, MDH officials, with assistance from researchers at the Mayo Clinic, analyzed a statewide database of billing records from medical providers for the year 2014. They looked at 18 low-value services that mainly fall into two categories: diagnostic imaging and disease screening.
The analysis revealed about 92,000 instances that year of Minnesotans receiving diagnostic imaging — X-rays, computed tomography (CT) scans or magnetic resonance imaging (MRI) — in situations where such tests are widely recognized as providing low diagnostic value. Most of those situations involved uncomplicated headaches or nonspecific low-back pain.
In such cases, imaging is unlikely to change the course of treatment or management, the MDH report points out. Furthermore, the imaging is not risk-free. It exposes patients to low doses of ionizing radiation, and ambiguous results from the tests may lead to other low-value health services “that place the patient at risk for adverse health events and cause stress and anxiety,” the report explains.
The MDH analysis also identified about 69,000 instances of low-value screening for cancer or carotid artery disease (narrowing of the major arteries in the neck that supply blood to the brain). These unnecessary tests included cervical cancer screening for women younger than 21 and older than 84, colorectal cancer screening in adults aged 85 and older, prostate specific antigen (PSA) screening for prostate cancer in men aged 75-plus, and screening for carotid artery stenosis in asymptomatic adults.
“Low-value screening does not carry as many direct risks for patients as low-value imaging,” the MDH report points out, “but the mental anxiety of a false positive result, as well as the ensuing tests and procedures, may produce adverse events or poor outcomes for patients.”
In addition, the analysis uncovered about 15,000 instances in 2014 of unnecessary tests — mostly chest X-rays — given to patients before they underwent low-risk surgery.
“Such tests do not provide information that is likely to alter a patient’s treatment plan,” the MDH report notes.
Most of Minnesota’s unnecessary health services were delivered in outpatient clinics or doctors’ offices, but they also occurred in hospital outpatient departments and emergency departments.
The total cost to Minnesotans of just those 18 different types of unnecessary procedures in 2014 was $54.9 million.
And, “although much of the research to date about low-value services has been about Medicare patients, … commercial payers accounted for two thirds ($29.1 million) of observed spending on the [low-value] services,” the report says. “Medicare was the second highest payer, accounting for 21 percent of total spending ($10.7 million), roughly evenly split between managed care and traditional fee-for-service plans.”
Almost 17 percent of the cost for the unnecessary services — or $9.3 million — was paid for directly by patients in the form of co-pays, deductibles or other out-of-pocket fees. People with commercial health plans incurred most (81 percent) of those costs.
Needed: a culture change
To stem the current epidemic of unnecessary and unhelpful health services, all Minnesotans — patients as well as providers — will need to develop a more skeptical and evidence-based attitude about medical care.
In the words of the Choosing Wisely campaign, patients need to make sure their medical care is
- supported by evidence
- not duplicative of other tests or procedures already received
- free from harm
- truly necessary
“Reducing low-value services requires a culture change for patients and providers to recognize that ‘more’ isn’t always ‘better,’ when it comes to imaging and screening,” said Dr. Rozalina McCoy, a Mayo Clinic endocrinologist who helped with the report’s analysis, in the released statement. “In fact, many of these tests and procedures are not just ‘low value’ and therefore a poor use of health care resources, but they can cause real harm to patients who receive them.”
FMI: You can read the MDH report on the department’s website. For more information about the Choosing Wisely campaign, including a list of overused and unnecessary procedures, go to the campaign’s website.