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October 12, 2021

Why “Just To Be Safe” Is Actually More Dangerous


New data shows us that one of the largest drivers of bad health outcomes and ballooning healthcare costs is medical testing. Most people agree that getting an unnecessary surgery is bad, but believe that it is “better to be safe than sorry” when it comes to receiving additional medical tests. After all, most tests are minimally invasive and can help spot issues before they get worse. However, the data shows us that each year 70 million patients in the US receive a test that lowers their life expectancy, leading to 25,000 excess deaths and an additional $420B in healthcare costs.

How can low-cost testing create such negative outcomes? The reason is that there is significant harm in “false positives'' where the test shows that a patient has a disease that they actually do not. As shown below, our national patient database shows us that 1 in 10 patients who receive an unnecessary test will undergo a major surgery they do not need, 1 in 200 will have a serious complication from that surgery and 1 in 1,000 will die. Unfortunately, our current healthcare system pays doctors for performing these additional unnecessary tests. Thankfully, there are doctors in every community that follow best practices with their usage of testing, which lowers costs and improves patient health. At Garner we help employers structure their health benefits to drive more care to these high quality doctors.

To illustrate the impact of this additional testing, we’ll walk through a case study of one of the most prevalent types of unnecessary tests: electrocardiograms (EKGs). An EKG is a common and painless test used to quickly detect heart problems. EKGs are great tools for patients experiencing heart-related symptoms, such as chest pain, palpitations, or shortness of breath. However, this test is often performed as part of a routine wellness check for adults “just to be safe.” This test is so prevalent that over 20% of healthy adults receiving an annual physical will undergo an unnecessary EKG every year. To show the impact of this unnecessary testing, we looked at what happens to healthy adults who receive an EKG compared to those who do not. Our extensive data analysis paints a clear picture: when EKGs are done inappropriately, it sets off a cascade of more procedures, higher costs, and worse health outcomes overall. To start, you can see that EKGs do not actually help identify any increased risk of heart attack or cardiac arrest. In fact, patients who receive the test actually have a 5% higher mortality rate than those who do not.

Why does the risk of death increase when receiving an EKG? Studies have found that out of 100 patients who are actually healthy and undergo an EKG, over 30 will receive an abnormal result. Following an abnormal EKG, patients often undergo a series of additional tests and even invasive procedures. As you can see in the chart below, patients who receive an unnecessary EKG are 17% more likely to undergo invasive angiography, 26% more likely to receive a stent, and 47% more likely to face a serious complication.

Beyond the health outcomes, receiving an inappropriate EKG significantly increases the cost of care for healthy adults. As shown below, the average amount of cardiac care for the healthy patients who did not receive an EKG was $350. This number ballooned to over $1,700 in average costs for healthy patients receiving an unnecessary EKG. So while the cost of an EKG is only $70, the additional follow on cost created by an unnecessary EKG is over $1,200.

This unfavorable relationship between benefits and harms is not just true for unnecessary EKGs, but for many other tests as well. Below we discuss other examples of the impact of unnecessary testing.

Imaging for back pain: For back pain, imaging is not recommended until patients have undergone a course of physical therapy. In fact, our data shows us that patients who receive imaging before trying PT are less likely to experience a relief of symptoms, as imaging can distract from the true source of pain and lead to unnecessary interventions. Patients receiving early imaging are more than twice as likely to undergo back surgery and experience surgical complications, incurring an additional $4K in medical expenses.

Routine prostate cancer screening: Routine prostate cancer screening (PSA) for men without a family history of or risk factors for prostate cancer leads to worse outcomes. Our data shows that, among this population, men who receive prostate cancer screening have no lower risk of getting late-stage prostate cancer, have nearly 3x the chance of having their prostate removed and experience an overall higher risk of death.

These common examples demonstrate the serious physical and financial harm that unnecessary tests cause. Given that most doctors are paid for the amount of tests they prescribe, receiving a test that is not recommended “just to be safe” happens incredibly frequently. This pattern is true even at the hospital systems with the best reputations for high-quality care. Thankfully, not all doctors perform medicine this way: in every community across the country, there are high-quality doctors that follow best practices when making decisions regarding tests and treatments. As the chart below shows, top performing doctors perform significantly fewer unnecessary tests, even relative to top hospital systems.

Ultimately, healthcare costs are reaching unsustainable levels for many employers, and patient outcomes are getting worse, not better. The above data on medical testing is only part of a broader picture that shows the growing cost of low quality and excessive medical care. At Garner, we believe that the key to reducing costs and improving quality is shifting care towards the best performing doctors. If you are interested in learning more about how Garner can help you achieve this, feel free to contact us for a customized health outcomes and savings report.

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