Tests as a revenue source

Tests are a significant source of revenue for medical establishments. As Elisabeth Rosenthal writes in The New York Times, “Testing has become to the United States’ medical system what liquor is to the hospitality industry: a profit center with large and often arbitrary markups.” As you might imagine, tests are often performed without a legitimate need for them. “It’s one of the most lucrative revenue streams they have,” according to Dr. Eric J. Topol, a cardiologist at Scripps Health in San Diego. In this case, he’s talking about echocardiograms—ultrasound pictures of the heart. He continues, “At many hospitals, the threshold for ordering an echocardiogram is the presence of a heart.” For example, one internist required that his patient have an echocardiogram before having elective cataract surgery. (The echocardiography professional society specifically advises against ordering the test for preoperative assessment of patients with no history or symptoms of heart disease.)

The cost of medical technology equipment is often the excuse for the high prices for some of the tests. But echocardiography equipment, as well as many other technologies, have become cheaper, just as high definition TVs have. Electrocardiography devices can now be purchased for as little as $5,000. Yet the charge for these tests remain high. Plus they vary from place to place. One patient was billed $1,400 at one location and $5,500 at another.

Angiograms are also performed unnecessarily. (Angiograms look for blocked arteries, using a thin tube injected with dye that can be shown on X-rays.) Every year in the United States, more than a million people get an angiogram, frequently without a sound basis for doing so—such as people who have no symptoms of heart problems but perhaps high cholesterol. The American College of Cardiology sponsored a study of such cases, which consisted of nearly two million angiograms. The researchers found no significant artery blockages in 62 percent of the angiograms.

Finally, an article in The Annals of Internal Medicine concludes that, for people showing no symptoms of cardiac problems, stress tests, electrocardiograms and myocardial perfusion imaging have not been shown to improve patient outcomes and can lead to potential harm. The tests commonly produce false positives that lead to further unnecessary testing, and all involve extra expense.

You get the idea. I’m sure you could find many more examples.

Next week: My beef with prescription medicines.

For an introduction to this blog, see I Just Say No; for a list of blog topics, click the Topics tab.