Medical costs continue to skyrocket, and more than ever, healthcare consumers need to learn when to stay no.
One of the most frustrating parts of being a doctor is that third-party administrators such as NIA (National Imaging Associates) constantly deny tests such as an MRI when a patient is in pain. For years, doctors have been ordering MRI’s and other tests partly because they have little training in evaluating problems such as back pain but also because of the concern of missing a problem that may cause them to be in a malpractice case. Because so many of these expensive tests were ordered, insurance carriers hired third party administrators to slow down the process. This has created paperwork for doctors who now have to pre-certify the care. The process makes the patient wait for the approval which is often denied initially and then approved after the doctor requests to speak with the doctor at the company. This waiting period has reduced the number of tests performed since some patients feel better and do not pursue the test, while others may avoid it due to the costs which may hit their deductibles. Unfortunately, most insurance carriers continue to overpay for an MRI through insurance even though many of us can go to an MRI center and reduce the price by offering to pay cash.
With more procedures coming under question by insurance carriers, and even patients, now, more than ever, need to be good advocates for themselves.
The other day, a patient told me that he was having problems with balance. While I can see that he had problems due to a lack of flexibility that resulted in shoulder and chronic elbow pain, a neurologist he saw recently wanted to send him for tests, partially because he had a heart attack earlier in the year. The patient has noticed marked improvements in how he feels and functions but the doctor wanted more tests after his brain MRI was negative. I had spoken to him regarding the additional tests and the data it would provide and since he was in his late 70’s, he never thought about where these tests would lead, or what types of interventions they may open the door to. When I explained this and how the treatment path was leading him to a possible invasive procedure that may be unnecessary or even harmful to him, he began to rethink the idea of the tests and whether he thought he should do them.
Wasteful tests and their costs can add up. “A review of 1.3 million Washington state patients’ insurance claims last year, for example, found that an estimated $282 million out of a total $785 million (36%) was spent on “wasteful” or “likely wasteful” services. Some 46% of 1.52 million services examined were also deemed wasteful or likely wasteful, according to the report by the nonprofit Washington Health Alliance.”
At least half of all medical treatments are of unknown effectiveness according to the journal Medical Care Research and Review (MCRR). This is why second opinions should be required for many medical procedures, however, what about the tests.
For many stomach complaints, most of the tests for upper and lower GI are inconclusive. From a chiropractor’s standpoint, many of these patients may not have needed the tests if the doctor was able to identify problems in the musculoskeletal system that may have been responsible for the cramping and stomach symptoms. This is why part of the solution must be to make musculoskeletal training a more important part of medical education, both while in school and under continuing education credits doctors require yearly.
With regard to painful conditions, always choose conservative care first. Chiropractors are the most conservative and are able to offer people relief without the use of drugs or aggressive interventions, while their holistic approach to care offers a better understanding of why you hurt. While many people are fearful that something more serious may be wrong with them, the truth is, this happens rarely.
What is a patient to do?
Read the article below which offers some advice. It also may pay dividends to see a chiropractor, since many musculoskeletal complaints overlap physical complaints of internal origin. Internal origin complaints can also manifest themselves as muscular pain. Chiropractors are skilled at ruling out both, something medical providers need to become more skilled at.
How to avoid medical treatment you don’t need — or that may not work
Published: Aug 29, 2019 By MEERA JAGANNATHAN
‘Just because we live in 2019 doesn’t mean everything the doctor offers you is something that’s supported by evidence’
Unnecessary or potentially ineffective medical treatment is a hard pill to swallow, but patients can take some proactive steps to avoid it.
In fact, many treatments that doctors propose “are often on the basis of really incomplete information and tremendous uncertainty,” Vinay Prasad, a hematologist-oncologist and associate professor of medicine at Oregon Health and Science University, told MarketWatch. “Just because we live in 2019 doesn’t mean everything the doctor offers you is something that’s supported by evidence,” he said.
This wasteful medical spending can add up. A review of 1.3 million Washington state patients’ insurance claims last year, for example, found that an estimated $282 million out of a total $785 million (36%) was spent on “wasteful” or “likely wasteful” services. Some 46% of 1.52 million services examined were also deemed wasteful or likely wasteful, according to the report by the nonprofit Washington Health Alliance.