Frequency of Overused Ambulatory Clinical Activity

Today’s Managing Health Care Costs Indicator is $6.8 billion

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The Archives of Internal Medicine published a report this weekend of researchers who reviewed data from two standard national databases to ascertain how often physicians offered the top overused clinical activities in primary care. They then extrapolated the incremental cost of this low-value care across the entire population.

A disturbing percentage of office visits included inappropriate care.  Blood counts were not indicated more than half of the time they were performed, and four in ten kids prescribed antibiotics for sore throats probably didn’t need them.  A third of the time physicians prescribed expensive brand name statins when generics would have saved substantial money. How much money? I’ve truncated the ‘y’ axis here – the brand name statin use is responsible $5.8 billion in excess cost, for the overwhelming majority of excess cost in this study.

The researchers used the Medicare fee schedule and prices, so this underestimates the actual cost of excess office-based care and overestimates drug costs, as pharmacy benefit managers get lower prices.  This is a study based on claims only.  Researchers did not review charts to find subtle reasons for these clinical activities, so this could overstate excess care.
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The $6.8 billion in excess cost is nothing to sneeze at – but removing all of these costs wouldn’t make much of a dent in our $2.3 trillion total health bill.   The generic statin issue will be largely solved, as Lipitor becomes available generically as early as next month and will presumable drop dramatically in price by mid 2012. The resource cost to do an extra blood count, blood chemistry, or EKG is only a tiny fraction of the allowable charge.  

There is a lot of room to improve clinical practice in this country. However, we continue to face mainly a price issue – and eliminating all the overutilization identified in this study would only lower the cost of health care by a quarter of a percent.

Thanks to Eyal Zimlichman, MD for pointing out this article.