More than a million Washingtonians got unnecessary medical treatment in one year

Low-cost, yet wasteful medical procedures cost an estimated $341 million from July 2016 to June 2017, according to a new report by the Washington Health Alliance.

The report found over one million patients in Washington state received services that the medical community knows are unnecessary.

They weren’t big things like surgery. But instead, covered relatively inexpensive prescriptions and routine procedures, such as prescription opiates for acute low back pain, antibiotics for upper respiratory and ear infections and cardiac screening for people with a low risk of heart disease.

“The little things really add up,” said the report’s author, Susie Dade. “It drives premiums over time. It drives healthcare costs, both for the system and for the individual.”

Both doctors and patients are responsible for wasteful care, she said.

“They (patients) hear or read something and go to their doctor and say, ‘Gee, I think I need this.’ And when doctors only have a 10-minute visit with patients, sometimes it’s easier to just give them what they ask for rather than explain why they don’t need it and why it might hurt them,” Dade said.

Reducing wasteful care involves changing medical culture, said Jessica Martinson, a director at the Washington State Medical Association, which is a partner of Choosing Wisely, a national initiative aimed at reducing unnecessary medical care. (Washington Health Alliance is also co-sponsors the initiative in the state.)

“It requires a commitment to ensuring that the care patients receive is appropriate and necessary, and that you’re questioning the way that you’ve always done things,” she said.

The report used data for all health insurance claims for patients in Washington state with commercial insurance or Medicaid, and an analysis tool called the MedInsight Waste Calculator.

“Waste” is defined as services that are not consistent with evidence-based medical guidelines, specifically “medical treatments, tests and procedures that have been shown to provide little benefit in particular clinical scenarios and in many cases have the potential to cause physical, emotional and financial harm to patients,” according to the report.

The report found these services were the top ten most wasteful:

1. Opiates for low back pain that lasts less than four weeks
2. Antibiotics for upper respiratory and ear infections
3. Annual electrocardiograms or cardiac screening for low-risk individuals
4. Imaging tests, such as external or internal eye photography, for eye disease
5. Routine lab tests before low-risk procedures
6. Two or more concurrent antipsychotic medications
7. Routine prostate specific antigen (PSA) screening for prostate cancer
8. Annual cervical cancer screening for women (less-than-annual pap smears and HPV screening is recommended)
9. Unnecessary screening for Vitamin D deficiency
10. Prescribing NSAIDs for hypertension, heart failure or chronic kidney disease

Opioids, such as oxycodone and Percocet, have serious side effects, such as addiction and overdose, so the expert panel created by the Washington State Legislature, known as the Dr. Robert Bree Collaborative, does not recommended them to use first to manage acute pain.

The report found 105,906 people in the state were inappropriately prescribed opioids for low back pain in a single year, wasting $13 million.

Instead, evidence is mounting in favor of alternatives to medication.

“Acupuncture, for example, can be very useful for reducing opioid use for acute pain,” integrative pain practitioner Dr. Heather Tick at the University of Washington said. “Massage therapy also has some evidence for reducing opioid use as well, under certain circumstances.”

Patients looking to avoid unneeded medical care can have a conversation with their provider, Dade said, and ask questions such as, "Will this test help me?" "What are the side effects?" and "How much is it going to cost?"