Dr. Cheryl Bettigole, the chief medical officer for a New Jersey community health clinic, began hearing complaints from patients about receiving unexpected $1,000 lab bills for what the doctor had expected to be a simple $30 pap smear, a simple, cheap and reliable medical test that has saved countless lives from cervical cancer.
So Bettigole began checking into why the lab tests were now costing so much that some of her low-income female patients were skipping them—putting themselves at risk of dying from a curable disease. The answer Bettigole found doesn’t reflect well on the medical world, according to her write up in The New England Journal of Medicine. Laboratories offer unnecessary tests—including those for conditions rarely seen and for which no symptoms are present—and doctors or their staff simply check the boxes, unaware of the cost additions. According to Bettigole:
Laboratories have learned that one easy way to increase revenue is to make it easy for clinicians to order more tests. In the past year, I have been visited by multiple laboratory representatives touting “improved” tests, virtually all of which involve combination panels that can be easily ordered and that contain extensive lists of fairly esoteric tests. The single-vial women’s health test is being heavily marketed by multiple laboratories. It includes not only the Pap and HPV tests but also tests for multiple infections—including some we would rarely have tested for in the past—for which we often have no evidence of benefit. Costly tests that once would have required physicians to submit multiple collection vials and specimens can now be ordered with the Pap smear simply by clicking a single box in the electronic medical record. Nothing at any point along the way alerts either the clinician or the patient to the high costs of these tests or to the fact that there is little medical evidence to suggest that they are useful for most patients. It seems harmless, even possibly beneficial, to run these additional tests, and for our staff, it eliminates the risk of missing a test the doctor might have wanted to have run. The risk it poses, though—the one I face when a patient calls about a crippling bill—is that more and more women may choose not to undergo screening, afraid of the financial consequences.
For patients with good health insurance, the cost is invisible—and often lowered because of negotiated prices that uninsured patients can’t get.
For women without health insurance, the $1,000 or better for tests they don’t need comes out of their shallow pockets. So they turn down the tests, exposing themselves to advanced cervical cancer at risk of their own lives, and at even higher costs to the public health care system.
All because medical labs make it easy. Bettigole understands the problem:
“As health care costs grow and laboratories develop savvy marketing tactics resembling those deployed by pharmaceutical companies, it is becoming increasingly clear that physicians have an obligation to be good stewards of limited resources and to understand the financial effects that the orders we write have on our patients. We need to teach medical students and residents to see this as an important aspect of their responsibility to their patients. Furthermore, we need to advocate for a system in which information about the cost and benefit of diagnostic tests is readily available to patients and providers at the point of care. If we fail to do so, we risk not only our patients’ pocketbooks but also the gains we have made against cervical cancer and many other conditions. We contribute to spiraling health care costs and are doing real harm.
The question is, will the medical profession do anything about a problem that would seem to have a simple solution.