Comments on: Incentives promote unnecessary, excessive tests in the ER

By: Just To Be Sure: The Most Expensive Phrase In Medicine - Better Health

Just To Be Sure: The Most Expensive Phrase In Medicine - Better Health — Fri, 06 Nov 2009 15:01:07 +0000

[...] Kevin, MD linked to this, and I really must comment. [...]

By: Dex

Dex — Mon, 02 Nov 2009 14:02:49 +0000

This is why you don’t want to be a VIP in the emergency room–excessive testing. Go incognito, and try to get treated like it’s routine. If you have a problem with logistical issues, like waiting around for a bed after admission, then its time to make your position known, or call some high-gravity beings to pull for you.

By: GruntDoc » Blog Archive » Reviewing the Great ER Caper: Just to be sure.

Thu, 29 Oct 2009 06:25:09 +0000

[...] Kevin, MD linked to this, and I really must comment. [...]

By: Incentives promote unnecessary, excessive tests in the ER « The ACUTE CARE Blog: Non-Urban Emergency Medicine

Thu, 29 Oct 2009 04:21:20 +0000

[...] Incentives promote unnecessary, excessive tests in the ER Posted on October 29, 2009 by coptermedic From KevinMD: [...]

By: Nuclear Fire

Nuclear Fire — Thu, 29 Oct 2009 03:03:29 +0000

That doesn’t sound at all like GCA to this Rheumatologist. Looks like the Ophthalmologist agreed.

By: No out of pocket? Out of mind

No out of pocket? Out of mind — Wed, 28 Oct 2009 19:25:53 +0000

ER testing is not free for even well insured patients, most of the time (double coverage, or stop-loss provisions might apply rarely); the ER visit is costly, the tests usually have sigificant co-pays. MRI’s, no matter how well-indicated, usually come with a steep price tag for patients – the benefit of insurance is the hospital much stick to contracted fees and can’t bill the patient three times the cost, as they might with an uninsured patient. Blood tests, scopes, ekg’s, ultrasounds, – some are cheaper , some hurt, some have higher risk – tests are not “free” to patients on any level.

Patients who are there because of sickness want to know what is going on, they want to be well. That’s why they want a test.

What about that risk of arteritis mentioned above? Why isn’t that worth ruling out? It’s an emergency condition and the consequences of missing a narrow window of treatment is catastrophic.

If there was an objective sign of neurological impairment, why would even a physician patient be entrusted with the differential? Denial alone could interfere with a proper assessment of his own condition.

By: Anonymous

Anonymous — Wed, 28 Oct 2009 18:51:25 +0000

Those ED docs…. Making the poor neurology resident do all their work.

By: Kevin Sullivan

Kevin Sullivan — Wed, 28 Oct 2009 18:07:13 +0000

The reason for all the testing: The patient doesn’t have an immediate out-of-pocket cost, and the hospital charges the insurance carrier per test.

Patient: If I’m not paying for each test, test me all you want.

MD/Hospital: I get paid by the test, so I’m going to test.

By: Mark N. Simon, MD

Mark N. Simon, MD — Wed, 28 Oct 2009 17:20:03 +0000

Great piece and insight into one of the main reasons for the excessive costs in healthcare. Similar expenses are incurred when pregnant patients go to the hospital for minor complaints. Many times patients want testing done “just to be sure” that everything is okay with the pregnancy. Other times physicians order more tests “just to be sure” they didn’t miss anything. Frequently these patients are sent to the hospital after calling their doctor’s office because the office “wants to be sure” that they have been checked out. This overabundance of caution does nothing to actually help the patient and adds a great deal of cost to the system.

By: Hmmm

Hmmm — Wed, 28 Oct 2009 15:59:02 +0000

Wouldn’t someone have been worried about temporal arteritis? Missing a treatable, preventable (within a narrow window) cause of permanent blindness would be terrible, perhaps worth some investigation to rule out?