- A survey of 2,106 U.S. physicians found that, on average, they believe 20.6% of medical care is unnecessary, including 22% of prescriptions, 24.9% of tests and 11.1% of procedures.
- An overwhelming majority (84.7%) attributed overtreatment to fear of malpractice, according to the study in Plos One. Other oft-cited reasons were patient pressure (59%) and difficulty accessing medical records (38.2%).
- More than seven in 10 respondents said there is a chance profit encourages overtreatment, and most believed less fee-for-service reimbursement would reduce overutilization.
In addition to de-emphasizing fee-for-service payment, more than 55% of respondents said residents should be trained on appropriateness criteria and more than 50% said easier access to outside health records and more practice guidelines could reduce overtreatment.
The researchers said the fear of malpractice may be overblown, noting just 2-3% of patients injured through negligence take legal action. Paid claims have dropped by nearly half in the last decade, they add.
Future studies should focus on the most over-utilized tests and procedures by specialty, the researchers said.
The issues physicians cited run the gamut, but none are surprising. Efforts to address them have found various degrees of progress and of success.
Congress is currently busy putting out fires, but there is malpractice reform legislation in the works. In June, the House narrowly passed a law that would cap noneconomic damages in malpractice lawsuits at $250,000, and would limit fees lawyers can charge in these cases. It has the support of HHS Secretary Tom Price, who has stumped for malpractice law changes throughout his career.
Patients pressuring doctors into unneeded care could be addressed with better patient engagement and communication. A team of physicians focused on patient-centered care likely have a better shot at convincing someone the service they're requesting isn't necessary.
A particular word that springs to mind in considering difficulty doctors have in accessing patient records is interoperability. Some providers have to use more than one EHR system, and others are on outdated platforms. Many EHR vendors recognize interoperability that would make patient records easily available to providers as an area for improvement in their products.
Physicians ordered more than $9,500 in tests and treatments per person in the U.S. in 2014, according to the CMS. Total spending increased 5.3% from 2013, fueled in part by “therapeutic illusion” — the tendency for physicians to overprescribe treatments they deem effective.
Efforts to limit unnecessary medical care, such as the Choosing Wisely Campaign, have been hampered by the phenomenon, in which doctors overestimate the effects of their actions, according to an article published last year in the New England Journal of Medicine.
In 2015, a public-private partnership in California formed to help tackle the country’s $200 billion medical waste problem. Called Smart Care California, the coalition is initially focused on reducing elective cesarean sections, opioid use and overtreatment of patients with lower back pain. It serves more than 15 million patients in the state.