By Kevin Mikielski
“I told them that I just had a stress test two months ago.” This was the quote from one of my patients that I have been seeing for the past six years in my private cardiology practice. She is a 72 year old with diabetes who presented two months prior with worsening dyspnea. An exercise stress test with nuclear imaging was performed with normal results. She was then admitted at a local hospital with atypical chest and midepigastric pain. The EKG was normal and cardiac enzymes x 2 were negative. The admitting physician, not knowing previous tests were already performed, ordered another stress test. Again, my patient told the attending she had just had this test two months ago. Subsequently, her pharmacologic stress test and nuclear imaging studies were normal and she was promptly discharged and advised to follow-up with her outpatient physicians.
The above situation is not infrequently encountered in clinical practice. When my patient told me her story, I had one simple question, “Why does so much waste exist in our medical system?” Not only did she receive unnecessary radiation but Medicare forked over between $1000-1500 of wasted reimbursement. I continue to ask myself why the same costly test was repeated within a two month timeframe and not identified as duplication of care. My best explanation is that our healthcare system lacks interoperability. I speculate that her stress test would NOT have been repeated if the ordering physician had electronic access to her outpatient testing results. If the physician had a mechanism to obtain her prior stress test results in a few minutes time, the patient would likely have been discharged from the ER after her second set of negative cardiac enzymes.
However, what physician has time to call another physician’s office or hospital to obtain patient records? In our fast-paced medical system, it is far easier and quicker to repeat a test versus the time required to obtain the patient’s records, especially if there is no financial penalty. It is no wonder that there is an estimated 765 billion dollars per year of medical waste with 33% attributed to unnecessary testing.
A marked reduction in waste should definitely occur beginning in 2018 because that is when CMS has mandated interoperability. However, interoperability may still remain years away given CMS’s frequent implementation delays. In the meantime, we should all recognize our fiscal responsibility for not ordering unnecessary procedures, particularly when the answer to our clinical question may be only a phone call away.
Kevin Mikielski, DO, FACC, MBA, CPE, is a noninvasive cardiologist in Erie, Pennsylvania. He is in private practice and Vice President of Osteopathic Cardiology Associates, LLC.