Two reports issued last week by the Dartmouth Institute for Health Policy and Clinical Practice raise new questions about whether physicians order far too many tests, and whether some tests might be motivated more by economic rather than diagnostic or therapeutic reasons, whether subconsciously or not.
The first report, published in the Online First edition of Archives of Internal Medicine, points to a wide regional variation in the rate by which Medicare beneficiaries receive certain repeat tests, often with far more frequency than existing guidelines suggest they should be conducted.
For example, of the Medicare beneficiaries who underwent echocardiography within the three-year period between Jan. 1, 2004 and Dec. 31, 2006 (28.5% of the beneficiary population), nearly a third (31.1%) experienced a repeat test within a year and over half (55.2%) had a repeat test within three years.
But the percentage of retested patients varied dramatically depending on what region of the country they received care.
In Miami, for example, which had the highest rate of testing in three of six testing categories examined, 39% of patients received a repeat test within one year and 66% within three years. However, in Portland, OR, which had the lowest rate of repeat testing in three of six types of tests examined, 25.5% received a repeat echocardiogram within one year and 47.1% within three years.