Low-Value Testing: A High-Stakes Challenge
Did you know that low-value care, including unnecessary diagnostic tests, accounts for an estimated $101 billion of wasteful spending every year?* Add to that the preventable risks it can place on patients’ health, and it’s easy to see why low-value testing is considered such a high-stakes challenge.
However, what exactly do we mean when we say “low-value” testing? EviCore’s Associate Chief Medical Officer of Diagnostic Solutions, Dr. Sheldon Scheinert, explains it best:
“A service isn’t low value in and of itself. For example, a radiologic imaging procedure isn’t low value. What makes it low value is if it isn’t going to move the patient forward in their health care journey – from an accurate diagnosis to the most effective, evidence-based treatment.”
And when the wrong care is given, the consequences are wide-ranging.
The Risks and Costs
Low-value testing can have a significant negative impact on patient health outcomes. It can lead to missed or inaccurate diagnoses, ineffective treatments, and unnecessary radiation exposure in tests including CT scans.
“We often see tests ordered that may not be needed for a particular diagnosis, if another test involving lower radiation could give the same answer for the patient,” said Dr. Christine Dickinson, Executive Medical Director for Extended Clinical Solutions. “We’re always looking at patient safety and radiation risk when we’re evaluating and helping each provider make a choice.”
In addition to health risks, low-value testing can also result in unnecessary costs for patients. For example, the average copay for advanced imaging can cost between $319 and $630, depending on health plan coverage and where the test takes place.** This is especially significant if a test isn’t going to provide value to patient care and could lead to the need for even more tests.
EviCore’s Evidence-Based Solution
The solution to protecting patients from receiving low-value testing is rather simple: Just follow the evidence. When care aligns with the latest evidence-based medical guidelines and peer-reviewed literature, it is far more likely to deliver value to patients and our healthcare system more broadly.
EviCore’s medical directors use our comprehensive evidence-based guidelines to help determine the appropriateness of a requested test, treatment, or procedure or, in many cases, whether there’s a more fitting alternate recommendation. Updated at least twice a year, these guidelines are based on information from national medical societies, such as the American College of Radiology, as well as recently published, peer-reviewed medical studies. Physicians who are appropriately specialized create them, and external experts review them.
“The clinicians here care deeply about care quality and making sure every patient has the best health journey and achieves the best health outcomes possible,” said Eric Gratias, MD, EviCore’s Chief Medical Officer. “They show up every day trying to make that better.”
Want to view EviCore’s evidence-based clinical guidelines?
They’re available any time, right here on our website.
* Shrank WH, Rogstad TL, & Parekh N. (2019). “Waste in the US Health Care System: Estimated Costs and Potential for Savings.” Journal of the American Medical Association, 322(15), 1501–1509. https://doi.org/10.1001/jama.2019.13978
** Rosenkrantz AB, Sadigh G, Carlos RC, Silva E 3rd, & Duszak R Jr. (2018). “Out-of-Pocket Costs for Advanced Imaging Across the US Private Insurance Marketplace.” Journal of the American College of Radiolology, 15(4), 607–614.e1. https://doi.org/10.1016/j.jacr.2017.12.010