PhotoUnnecessary medical tests and procedures can be profit centers for healthcare providers, but they drive up the overall cost of health care.

In recent months, physicians have been calling attention to potential money-wasters in a bid to make the system more efficient. Along those lines, the American Academy of Dermatology has released new recommendations regarding dermatology tests and treatments that it says are not necessary and in most cases should be avoided.

“The American Academy of Dermatology and its members are committed to serving as good stewards of limited health care resources, and we want to empower our patients to make informed health care decisions,” said academy president Dr. Mark Lebwohl.

Conversation starter

He says the list can help patients with skin, hair, and nail conditions start a conversation with their dermatologist about what tests and treatments are right for them.

Items on the list include avoiding systemic corticosteroids as a long-term treatment for dermatitis. The academy says the potential complications of long-term treatment with oral or injected corticosteroids outweigh the potential benefits.

It urges patients to avoid skin prick tests or blood tests such as the radioallergosorbent test (RAST) for the routine evaluation of eczema. When testing for allergic conditions is necessary, it suggests patch testing with ingredients of products that come in contact with the patient’s skin.

Microbiologic testing is often used in the evaluation and management of acne, but the academy says it should not be an automatic, go-to treatment. In fact, the academy says it's generally unnecessary because it does not affect the management of typical acne patients.

Also making the list is routine use of antibiotics to treat bilateral swelling and redness of the lower leg. It should only be used, the academy advises, if there is clear evidence of infection. It also advises against routine use of antibiotics for inflamed epidermal cysts.

Patient participation needed

Doctors say informed patients can help reduce these unnecessary procedures because evidence shows that providers in all medical disciplines are slow to make changes in the way they have always done things. A recent study by researchers at NYU Langone Medical Center finds that despite these a growing number of peer-reviewed recommendations, no significant changes have occurred over a 14-year period in the rates of several kinds of pre-operative tests that have long been flagged as too expensive and unnecessary.

“Our findings suggest that professional guidance aimed at improving quality and reducing waste has had little effect on physician or hospital practice,” said Dr. Alana E. Sigmund, the lead investigator.

Among the tests that continue to be ordered are plain radiography, or x-rays done without contrast; hematocrit, or the measurement of the percentage of red blood cells; urinalysis, and cardiac stress testing.

The costs of the tests add up, considering 30 million Americans undergo surgery each year, and 60% of patients undergo ambulatory procedure, performed on an outpatient basis.

“While it’s important to ensure patients can safely undergo surgical procedures, many of these procedures are low-risk, and the tests rarely improve patient management,” said Dr. Joseph Ladapo, senior investigator on the study.

Ladapo doesn't attribute the continued testing to bill padding, but rather a hold-over from outdated residency training. Still, huge hospital mark-ups and unnecessary tests shed some light on fast-rising health care costs.

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