Unnecessary care is estimated to make up a third of total medical spending in the U.S. That’s about $750 billion a year.
Kaiser Health News’ Sept. 27 livestream on medical overtreatment was mostly geared toward a more general audience, but I found certain parts of it to be valuable to employers.
Annually millions of Americans, especially older adults, undergo screenings, tests and scans (like duplicate blood tests and unnecessary knee replacements) that don’t offer much benefit, according Kaiser Health News. Looking at this from an employer’s point of view, this made a lot of sense to me, considering what I’ve heard and read about overscreening in workplace wellness programs. Could irresponsible screenings contribute to higher health care costs for employers and employees?
The discussion also made me wonder about the flip-side of that argument: employees who can’t afford necessary treatment, surgery or medication because of expensive insurance or deductibles and copays they can’t afford. This dichotomy is interesting, and I wonder what potential solutions are to make necessary treatment affordable to one group of employees while also scrapping unnecessary care for others.
What’s the right amount of treatment, and who decides what the right amount is? The patient? The health care provider? The plan sponsor?
One panelist also brought up medication and situations in which overtreatment can occur here. Yes, medication used responsibly is a good thing. But in some cases, you have older adults who are on several medications — some of which have only been prescribed to offset the side effects of another one. Also, doctors aren’t generally taught how to “de-prescribe” medications. Anyone with a chronic condition may face problems with this.
I just brought up a lot of different things to think about. That’s what I find valuable about long discussions of public health issues: they tend to bring up a number of important tension points and considerations in the employer health care space, as well.
Not to worry, but there are plenty of third-party sources and pieces of research that begin to answer the many questions and dig deeper into these complexities.
The National Business Group on Health posted a blog about “3 Strategies Employers Can Use to Reduce Overtreatment” this year. It reported the top three reasons for medical overtreatment, according to a study from September 2017 — fear of malpractice lawsuits; pressure from patients to perform tests or procedures; and difficulty accessing medical records, leading to duplicate testing. Potential strategies for employers to combat this include changing incentives, contracting with leading health systems and educating employees about how to efficiently use the health care system.
The Society for Human Resource Management reported in 2016 about the overuse of screening in workplace wellness programs. Employers need to more strongly consider the value of certain tests for different subsets of the employee population, according to the article.
One potential danger of overscreening is false positives, test results which incorrectly indicate that a particular condition is present. The more screening employees undergo, that greater chances that a false positive will occur, and then that employee might have to go through additional tests to confirm the results. “Employers should ask about the rate of false positives for any given test and keep that rate in mind when considering the level of screening to offer in a wellness program,” the article stated.
The article also suggested that employers ask these two questions to wellness vendors who offer and recommend screenings: Why are these tests necessary? and what are accepted clinical guidelines for when, and under what circumstances, to administer them?
Employers: What are you doing to prevent overtreatment in your employee population? What strategies have you found to be effective? And what are you doing to combat undertreatment?