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Physician Checklist Zaps Wasteful Spending

Joe Cantlupe, for HealthLeaders Media, October 27, 2011

The working group homed in on seven areas of overuse, with specific cost savings in several cases:

1. Statins. Low-cost generic statins should be prescribed when initiating cholesterol-lowering treatment rather than high cost, brand-name drugs, saving $5.8 million annually.

2. Sinusitis. Antibiotics are prescribed in more than 80% of outpatient visits for acute sinusitis—accounting for 16 million physician office visits annually—but most cases are due to viral infection that will resolve on its own.

3. Imaging. Lumbar spine imaging for lower back pain before six weeks does not improve outcomes but increases costs. Back pain is the fifth most common reason for physician visits.

4. Electrocardiogram screening. Potential harms of annual ECG screening exceed potential benefits, Morioka-Douglas says. ECGs or other cardiac screening should not be performed annually for asymptomatic, low-risk patients.

5. Pap tests. They “don’t show much in women who’ve had a total hysterectomy for benign disease, and there is poor evidence for improved outcomes,” Morioka-Douglas says.

6. DEXA screening. Bone-density screening for osteoporosis is not cost-effective in younger, low-risk patients. Bone density testing in women under age 65 accounts for $527 million in annual costs.

7. Blood chemistry panels. It’s not necessary to order basic metabolic panels or urinalysis for screening in asymptomatic, healthy adults. When complete panels are performed on asymptomatic patients, only lipid screening yields significant numbers of positive results. Orders of complete blood counts for general medical examinations were associated with $40.8 million in costs.

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2 comments on "Physician Checklist Zaps Wasteful Spending"


Dr. Rob (10/27/2011 at 2:45 PM)
Unfortunately, much unnecessary care is driven by: 1.) patients wanting an "immediate" cure for their condition. IF they do not receive the treatment THEY think is required, from their Primary Care MD, they seek treatment elsewhere. Who will educate the consumer, when they are "educated by the media" to make their own informed decisions ? 2.) Many "wasteful" diagnostic test are a result of practicing "defensive medicine". Most MD's will be happy to stop ordering these tests when plaintiff attorney's, and their "expert witnesses" stop referring to them as "standards of care" in lawsuits. Who will educate them, and assume the liability?

Karyn (10/27/2011 at 2:25 PM)
Nice job. How about not giving out controlled substances like candy. Lots of post op patients get 30 - 60 or more Vicodin, Oxycontin, etc and use between 5 and 7. Some of the problem is the 3rd party payors only allow for the docs to write a minimum of 30. This leads to over use. abuse and how to dispose of what was not used. How about a smaller amount with a refill.