'Unnecessary' care by PCPs costs $6.7 billion a year

There may be a good reason why primary care physicians (PCPs) feel as if they often provide more care than is really needed. They actually do, according to a research letter published recently in Archives of Internal Medicine, and that excessive treatment cost $6.7 billion in 2009.

For the report, researchers at the Mount Sinai School of Medicine in New York attributed the cost to performing unnecessary tests or prescribing unnecessary medications in primary care, noting that 86% of the expense could be attributed to prescribing brand-name statins instead of generics.

In a recent survey of PCPs, the results of which were published in the same journal, 42% of respondents said they believed patients in their practices received too much care; these survey participants suggested that malpractice reform, realignment of financial incentives, and having more time with patients could relieve some of that pressure.

For the research letter, Minal Kale, MD, a postdoctoral fellow at the Mount Sinai School of Medicine, and colleagues reviewed findings from a study published in a May issue of the Archives of Internal Medicine, which identified the five most overused clinical activities in each of three specialties they defined as primary care: pediatrics, internal medicine, and family medicine. Then they performed a cross-sectional analysis of separate data from the National Ambulatory Medical Care Survey and the National Hospital Ambulatory Medical Care Survey, discovering that more than $6.7 billion of primary care spending in 2009 was excessive.

“Our analysis shows astronomical costs associated with prescribing of brand-name statins when effective, generic alternatives were available. Efforts to encourage prescribing of generics clearly have not gone far enough,” Kale wrote. “Additionally, millions are spent on unnecessary blood work, scans, and antibiotic prescriptions. Significant efforts to reduce this spending are required in order to stem these exorbitant activities.”

In addition to prescribing of brand-name statins, remaining excess costs included: 

$32 million for blood work ordered but not needed;

$527 million for needless bone density scans in younger women;

$175 million for computed tomography scans, magnetic resonance imaging, or x-rays in patients presenting with back pain; and

$116 million in over-prescription of antibiotics for sore throats in children who did not have fever and/or strep.

Unnecessary annual echocardiograms, urine testing, pap smears, and pediatric cough medicine prescriptions also were components of excess costs, according to the research letter.

“We found considerable variability in the frequency of inappropriate care; however, our data show that even activities with small individual costs can contribute substantially to overall healthcare costs,” Kale added. “In light of the current healthcare reform debate, we need more research examining how overuse contributes to healthcare spending. Research might focus on the potential role of reimbursement, defensive medicine practices, or lack of adherence to guidelines.”

Go back to the current issue of eConsult.