Lack of Coordinated Health Care Means Unnecessary Tests and Procedures

By Sondra Forsyth

Uncoordinated health care services are linked to higher rates of unnecessary medical tests and procedures among Medicare patients, according to a new study from Johns Hopkins researchers.

In the report, published in JAMA Internal Medicine, the investigators analyzed 5 percent of Medicare claims using a previously validated set of 19 over-used procedures and a measure of so-called continuity of care.

According to a release from Johns Hopkins, the results showed that 14.7 percent of patients were subjected to at least one potentially overused diagnostic, screening, monitoring or treatment procedure in 2008. Overall, patients who had more continuity in their medical care had a lower chance of having an overused procedure. In particular, higher continuity was significantly associated with lower odds of nine procedures (six out of 13 diagnostic tests and three out of three therapeutic procedures).

Higher continuity was associated with increased overuse for just three procedures: routine monitoring of digoxin, an MRI of the lumbar spine for low back pain prior to conservative therapy, and thorax CT scans with and without contrast.

“Increased continuity was associated with lower rates of overuse,” said lead author Max Romano, M.D., M.P.H, a medical student at the Johns Hopkins University School of Medicine and the Johns Hopkins Bloomberg School of Public Health, “suggesting a potential benefit of high-continuity care,” although the strength and direction of the association varied according to the specific procedure.

“Conservative estimates suggest that 30 percent of all health care spending nationwide — roughly $600 billion annually — could be eliminated without any decrease in health care quality,” says Romano. “This research is important because it suggests that fractured patient care is related to this massive amount of overuse.”

“The scale of overuse is mindboggling,” Romano said. “Unfortunately, patients just don’t know which procedures are necessary and which aren’t. They have to put a lot of trust in the health care system and providers. The fragmented health care system may make it harder for their providers to make the best decisions.”

The researchers said they hoped the issue would be investigated more deeply.