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What you should ask a doctor to avoid wasted healthcare costs

LISTEN: Marshall Allen on Washington state's wasted healthcare costs

A new study by the Washington Health Alliance found that in a one-year span more than 600,000 patients in Washington received treatment they didn’t need, costing an estimated $282 million in wasted healthcare costs.

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“This study just looked at commercially insured patients who had received one of 47 tests or services that medical experts have flagged as often being overused,” ProPublica healthcare expert Marshall Allen told KIRO Radio’s Dave Ross. “So these are things like cervical cancer screenings that are performed on women who have had adequate prior screenings.”

Allen said that one of the things that wasted the most healthcare dollars was doing comprehensive lab tests on healthy patients before they underwent elective surgery.

“They found that about 85 percent of the lab tests that are used to prep healthy patients for low-risk surgery were unnecessary. And they estimated that that alone squandered about $86 million in Washington in that one-year time period,” Allen said.

The metrics used to determine the costs of the procedures were created by the U.S. Preventative Services Taskforce and the Choosing Wisely Campaign, part of the American Board of Internal Medicine.

“Obviously all these medical interventions are important and very necessary when you actually need them,”Allen said. “But if you don’t actually need them, they can actually expose you to a lot of harm. There are a lot of complications that can arise out of these. And also it costs a lot of money.”

Doctors are in agreement about these findings, Allen said. In fact, doctors themselves decided on the 47 procedures included in the study.

“These are actually not very controversial measures,” he said. “I called both the Washington State Medical Association, which represents the doctors, and I called the Washington State Hospital Association, and neither of them quibbled with the findings of this study.”

A major part of the problem is that our healthcare system is fee-for-service, Allen said.

“That means that people get paid more when they do more. Sometimes people call it that you get to eat what you kill,” he said.

Solution to wasted healthcare costs

Susan Dade, the deputy director of the Washington Health Alliance, said that one way to reduce the state’s wasted healthcare costs could be to teach patients about the necessity and the price of certain medical procedures.

“Why don’t we promote conversations between doctors and patients that helps educate when these things are smart to use and when they don’t really add anything to the course of care?” she said. “When they don’t add anything, let’s not do them. Because they cost money. They don’t help, and they may actually harm down the road.”

Dade advocates that people ask their doctors these five questions:

  1. Do I really need this test?
  2. What are the risks and side effects?
  3. Are there simpler and safer options?
  4. What happens if I don’t do anything?
  5. How much does it cost and will my insurance pay for it?

Patients should know ahead of time what they will pay for healthcare services, Dade said. And doctors, who don’t always know the price of the procedures they are performing, should have that knowledge as well.

“We all have a role to play in helping patients understand that they’re at risk,” she said. “That risk could be from physical harm. It could also be from financial harm. They’re at potential risk every time they take a pill, get a test, get a procedure. They are entitled to understand the risks and the benefits and how much it’s going to cost them before they make their decision.”

Listen to the full interviews with Marshall Allen and Susan Dade on Seattle’s Morning News here.

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