Pediatricians contribute to $6.7 billion annual cost of overtreatment

Instead of too little, too late, in terms of medical care, are your patients getting too much, too soon?

Pediatricians and other primary care physicians overtreat patients at a cost of $6.7 billion a year, according to recent research. Investigators at Mount Sinai School of Medicine, New York, attributed the costs to performing unnecessary tests or prescribing unneeded medications.

Minal Kale, MD, and colleagues reviewed findings from a study that identified the top 5 most overused clinical activities in each of 3 primary care specialties: pediatrics, internal medicine, and family medicine. They did cross-sectional analysis of separate data from the National Ambulatory Medical Care Survey and the National Hospital Ambulatory Medical Care Survey.

“Millions are spent on unnecessary blood work, scans, and antibiotic prescriptions. Significant efforts to reduce this spending are required in order to stem these exorbitant activities," Kale said.

Pediatricians were far from the worst offenders-86% of the $6.7 billion could be attributed to prescribing brand-name statins instead of generics, overwhelmingly to adults. In addition, pediatricians probably had little role in the $527 million for needless bone density scans in younger women.

However, the study noted that $116 million was spent for overprescribing antibiotics for sore throat in children who did not have fever and/or strep. Other costs involved the full spectrum of primary care, including $32 million for blood work; $175 million for computed tomography scans, magnetic resonance imaging, or x-rays in patients presenting with back pain; or unspecified but unnecessary costs for urine testing or pediatric cough medicine prescriptions.

The issue of antibiotic overprescribing is not new. The Centers for Disease Control and Prevention (CDC) reported that 58% of the antibiotics prescribed by office-based physicians in 2007–2008 were for acute respiratory infections that usually don’t require antibacterial treatment. Antibiotic prescriptions often are written because antibiotic-resistant infections are “common outpatient diagnoses for which patient expectations, as well as physician behavior, contribute to inappropriate antibiotic use.”

The Mount Sinai researchers pointed out that even small changes in practice could make a big difference.

“We found considerable variability in the frequency of inappropriate care; however, our data show that even activities with small individual costs can contribute substantially to overall healthcare costs," Kale said. "In light of the current healthcare reform debate, we need more research examining how overuse contributes to healthcare spending. Research might focus on the potential role of reimbursement, defensive medicine practices, or lack of adherence to guidelines.”

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