Dr. Clif CleavelandMy last column summarized the case of a man whose fainting episode resulted in overnight hospital charges exceeding $40,000. The itemized statement from his hospitalization identified imaging and lab tests as the major expense.
A patient with health insurance that includes a large deductible or co-payment can owe thousands of dollars after emergency or in-patient care. The challenge for our health care system is to find ways to control costs without sacrificing quality, safety and effectiveness. Because an estimated 30 percent of U.S. health care costs are wasted, substantial savings should be attainable.
There are several approaches to this problem. None are easy. Each requires cooperation between patients and their families and providers.
• Education on costs. Many physicians and other providers are unaware of the cost to the patient of medical tests including bloodwork and imaging studies. This is especially true in training centers in which high-tech diagnostic facilities abound and extensive testing is the norm. From medical training forward, costs and appropriate use of services must be emphasized. With each new technology, cost must be factored into the question of clinical usefulness. Costs must be highlighted in every clinical setting. Patients will benefit from awareness of costs and potential side-effects of diagnostic tests.
• Clinical guidelines. Many recommended pathways for diagnosis exist. The problem is their voluntary nature. More rigorous adherence to guidelines for employing MRIs and other high-priced imaging procedures would lessen inappropriate use. Acute-care providers worry about litigation if a condition is not diagnosed in a timely manner. If providers adhere to established guidelines when evaluating a patient, they should be absolved from blame if some unanticipated abnormality is subsequently detected. Ideally, guidelines would encourage more attention to obtaining a careful history and performing a physical exam before ordering diagnostic studies.