President Obama's healthcare reform law focuses in part on reducing "unnecessary care," or tests and procedures ordered for reasons other than medical necessity. Despite the goal's good intentions, many physicians object to the push to reduce "unnecessary care," saying reality often forces the hand of providers prescribing care. In some cases, patients need multiple tests to diagnose a difficult problem; in others, the patients request those tests regardless of physician advice. If a patient dies because a physician skipped a test that could have provided a solution, the physician could be sued for malpractice — a costly, time-consuming and stressful process.
According to the Medscape Physician Compensation Report: 2012 Results, the majority of physicians (67 percent) said they do not plan to reduce the number of tests, procedures and treatments they perform. Only about a quarter of physicians (27 percent) said they would reduce the number of tests and procedures because the guidelines are valid. These numbers do not bode well for this aspect of healthcare reform; despite a push by hospitals and governmental agencies to reduce redundant or avoidable care, a lack of physician support may signal a death knell for the initiative.
Why physicians order unnecessary care
Interestingly, physicians and policymakers seem to be on the same page about the issue of unnecessary care — they just don't agree on a solution. In a nationwide survey of 627 internists and family care physicians published in the Archives of Internal Medicine, 43 percent believed that much of the healthcare received in the United States is unnecessary. Twenty-eight percent acknowledged that they were personally ordering more tests and referring more patients to specialists than they would "ideally like to be."
But acknowledging the problem doesn't mean an end to it. According to the survey, 76 percent of physicians blamed malpractice concerns as the cause of unnecessary care. Eighty-three percent of physicians thought they could be sued for not ordering a test, suggesting that tests are ordered simply to avoid the possibility — however remote — of a lawsuit. Another 52 percent said they ordered excess tests and other procedures because they were under pressure to meet clinical performance measures, which are used to evaluate physicians' job performance.
Forty percent of physicians blamed their workload, saying time constraints made it difficult to determine the cause of medical complaints for many patients. In those cases, they ordered tests to get answers. While most physicians did not admit to personally ordering extra tests to generate more income, they said that "other" primary care physicians would order fewer diagnostic tests if not for the financial incentive. They were even more accusatory towards specialists.
The break-down by specialty
In the Medscape survey, physicians most commonly responded that they would not follow "unnecessary care" guidelines because of defensive medicine or patient welfare concerns. Of those profiled below who believed in the guidelines, cardiologists, internists and family medicine physicians were the most likely to try and prevent unnecessary care. Ophthalmologists, orthopedic surgeons and ER physicians were least likely to trust the guidelines. The statistics below detail how each specialty responded to the question on preventing unnecessary care.
Cardiologists
No, because I am still going to practice defensive medicine: 20%
No, because these guidelines are not in the patient's best interest: 38%
Yes, because they affect my income: 9%
Yes, because they are good guidelines: 32%
Emergency medicine physicians
No, because I am still going to practice defensive medicine: 36%
No, because these guidelines are not in the patient's best interest: 25%
Yes, because they affect my income: 25%
Yes, because they are good guidelines: 14%
Family medicine
No, because I am still going to practice defensive medicine: 23%
No, because these guidelines are not in the patient's best interest: 39%
Yes, because they affect my income: 7%
Yes, because they are good guidelines: 31%
Gastroenterologists
No, because I am still going to practice defensive medicine: 29%
No, because these guidelines are not in the patient's best interest: 40%
Yes, because they affect my income: 9%
Yes, because they are good guidelines: 23%
General surgeons
No, because I am still going to practice defensive medicine: 27%
No, because these guidelines are not in the patient's best interest: 44%
Yes, because they affect my income: 7%
Yes, because they are good guidelines: 22%
Internists
No, because I am still going to practice defensive medicine: 23%
No, because these guidelines are not in the patient's best interest: 31%
Yes, because they affect my income: 9%
Yes, because they are good guidelines: 36%
Neurologists
No, because I am still going to practice defensive medicine: 20%
No, because these guidelines are not in the patient's best interest: 49%
Yes, because they affect my income: 7%
Yes, because they are good guidelines: 24%
Ophthalmologists
No, because I am still going to practice defensive medicine: 21%
No, because these guidelines are not in the patient's best interest: 60%
Yes, because they affect my income: 9%
Yes, because they are good guidelines: 10%
Orthopedic surgeons
No, because I am still going to practice defensive medicine: 30%
No, because these guidelines are not in the patient's best interest: 46%
Yes, because they affect my income: 7%
Yes, because they are good guidelines: 16%
Radiologists
No, because I am still going to practice defensive medicine: 26%
No, because these guidelines are not in the patient's best interest: 47%
Yes, because they affect my income: 9%
Yes, because they are good guidelines: 18%
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According to the Medscape Physician Compensation Report: 2012 Results, the majority of physicians (67 percent) said they do not plan to reduce the number of tests, procedures and treatments they perform. Only about a quarter of physicians (27 percent) said they would reduce the number of tests and procedures because the guidelines are valid. These numbers do not bode well for this aspect of healthcare reform; despite a push by hospitals and governmental agencies to reduce redundant or avoidable care, a lack of physician support may signal a death knell for the initiative.
Why physicians order unnecessary care
Interestingly, physicians and policymakers seem to be on the same page about the issue of unnecessary care — they just don't agree on a solution. In a nationwide survey of 627 internists and family care physicians published in the Archives of Internal Medicine, 43 percent believed that much of the healthcare received in the United States is unnecessary. Twenty-eight percent acknowledged that they were personally ordering more tests and referring more patients to specialists than they would "ideally like to be."
But acknowledging the problem doesn't mean an end to it. According to the survey, 76 percent of physicians blamed malpractice concerns as the cause of unnecessary care. Eighty-three percent of physicians thought they could be sued for not ordering a test, suggesting that tests are ordered simply to avoid the possibility — however remote — of a lawsuit. Another 52 percent said they ordered excess tests and other procedures because they were under pressure to meet clinical performance measures, which are used to evaluate physicians' job performance.
Forty percent of physicians blamed their workload, saying time constraints made it difficult to determine the cause of medical complaints for many patients. In those cases, they ordered tests to get answers. While most physicians did not admit to personally ordering extra tests to generate more income, they said that "other" primary care physicians would order fewer diagnostic tests if not for the financial incentive. They were even more accusatory towards specialists.
The break-down by specialty
In the Medscape survey, physicians most commonly responded that they would not follow "unnecessary care" guidelines because of defensive medicine or patient welfare concerns. Of those profiled below who believed in the guidelines, cardiologists, internists and family medicine physicians were the most likely to try and prevent unnecessary care. Ophthalmologists, orthopedic surgeons and ER physicians were least likely to trust the guidelines. The statistics below detail how each specialty responded to the question on preventing unnecessary care.
Cardiologists
No, because I am still going to practice defensive medicine: 20%
No, because these guidelines are not in the patient's best interest: 38%
Yes, because they affect my income: 9%
Yes, because they are good guidelines: 32%
Emergency medicine physicians
No, because I am still going to practice defensive medicine: 36%
No, because these guidelines are not in the patient's best interest: 25%
Yes, because they affect my income: 25%
Yes, because they are good guidelines: 14%
Family medicine
No, because I am still going to practice defensive medicine: 23%
No, because these guidelines are not in the patient's best interest: 39%
Yes, because they affect my income: 7%
Yes, because they are good guidelines: 31%
Gastroenterologists
No, because I am still going to practice defensive medicine: 29%
No, because these guidelines are not in the patient's best interest: 40%
Yes, because they affect my income: 9%
Yes, because they are good guidelines: 23%
General surgeons
No, because I am still going to practice defensive medicine: 27%
No, because these guidelines are not in the patient's best interest: 44%
Yes, because they affect my income: 7%
Yes, because they are good guidelines: 22%
Internists
No, because I am still going to practice defensive medicine: 23%
No, because these guidelines are not in the patient's best interest: 31%
Yes, because they affect my income: 9%
Yes, because they are good guidelines: 36%
Neurologists
No, because I am still going to practice defensive medicine: 20%
No, because these guidelines are not in the patient's best interest: 49%
Yes, because they affect my income: 7%
Yes, because they are good guidelines: 24%
Ophthalmologists
No, because I am still going to practice defensive medicine: 21%
No, because these guidelines are not in the patient's best interest: 60%
Yes, because they affect my income: 9%
Yes, because they are good guidelines: 10%
Orthopedic surgeons
No, because I am still going to practice defensive medicine: 30%
No, because these guidelines are not in the patient's best interest: 46%
Yes, because they affect my income: 7%
Yes, because they are good guidelines: 16%
Radiologists
No, because I am still going to practice defensive medicine: 26%
No, because these guidelines are not in the patient's best interest: 47%
Yes, because they affect my income: 9%
Yes, because they are good guidelines: 18%
Related Articles on Healthcare Reform:
Employers Could Drop Insurance After 2014, Republicans Say
Reforms to New York State Program Address Physician Shortage
How Will CMS' Proposed FY 2013 IPPS Rule Affect Quality Improvement Reporting Efforts?