There are many tips to saving money on medical costs like asking your doctor only for generic medications, choosing an insurance plan with a high deductible and lower monthly premiums, going to an urgent care or retail clinic rather than the emergency room, and getting prescriptions mailed rather than go to a pharmacy.

How about getting your old medical records and having them reviewed by a primary care doctor?  It might save you from having an unnecessary test or procedure performed.

Research shows that there is tremendous variability in what doctors do.  Shannon Brownlee’s excellent book, Overtreated – Why Too Much Medicine Is Making Us Sicker and Poorer, provides great background on this as well as work done by the Dr. Jack Wennberg and colleagues on the Dartmouth Atlas. Some have argued that because of the fee for service structure, the more doctors do the more they get paid.   This drives health care costs upwards significantly.  Dr. Atul Gawande noted this phenomenon when comparing two cities in Texas, El Paso and McAllen in the June 2009 New Yorker piece.

Between 2001 and 2005, critically ill Medicare patients received almost fifty per cent more specialist visits in McAllen than in El Paso, and were two-thirds more likely to see ten or more specialists in a six-month period. In 2005 and 2006, patients in McAllen received twenty per cent more abdominal ultrasounds, thirty per cent more bone-density studies, sixty per cent more stress tests with echocardiography, two hundred per cent more nerve-conduction studies to diagnose carpal-tunnel syndrome, and five hundred and fifty per cent more urine-flow studies to diagnose prostate troubles. They received one-fifth to two-thirds more gallbladder operations, knee replacements, breast biopsies, and bladder scopes. They also received two to three times as many pacemakers, implantable defibrillators, cardiac-bypass operations, carotid endarterectomies, and coronary-artery stents. And Medicare paid for five times as many home-nurse visits. The primary cause of McAllen’s extreme costs was, very simply, the across-the-board overuse of medicine.

Doctors apparently seemed to order more tests.  Patients, not surprisingly, agreed.  After all, without adequate medical knowledge or experience, how sure would you be if a doctor recommended a test and you declined?

Would doctors do more because they get paid more or would they simply do the right thing and do tests or procedures when only medically necessary?

I recently had a 55 year old healthy woman join my practice.  She wisely had brought in her medical records and was fairly educated on the care she received.  She told me that her previous doctor had recommended a colonoscopy for this year, five years after her initial colonoscopy at age 50.

Odd.

For most patients with no family history of colon cancer and a normal colonoscopy, recommendations are to repeat in ten years not five.

Did she have any abdominal pain or change in bowel habits?  No.

Did the doctor say anything about colon polyps or growths?  No.

Did she have the colon biopsied?  No.

Was there a family history of colon cancer?  No.

She was pretty sure she was to have a repeat test five years later.

I reviewed her previous doctor’s chart which had her colonoscopy report.

Completely normal colonoscopy.  No polyps.  No growths.  No biopsy.

At the end of the report:  Recommend repeat colonoscopy in 5 years.

I’ve read news reports over the years where research has noted some gastroenterologists were doing colonoscopies more frequently than recommended by their own professional medical societies either for routine screening or follow-up of colon polyps and growths.  I assumed those stories were outliers and rare.  I would never encounter such an obvious case of overtreatment.

But this patient’s report and her memory of what her doctor told her could not be chalked up to a typo or a misunderstanding.  Would doctors do more because they get paid more?  How else to explain this?

After showing my patient the guidelines from the American Cancer Society as well as the American College of Gastroenterology, she was thrilled that she didn’t need to undergo the procedure for another five years.  No need to do the prep that Dr. Oz did with the gallon of laxative and the loss of a day getting ready and then recovering from the side effects of IV sedation needed for the colonoscopy.

I saved her time and money and unnecessary treatment.

You should always have a primary care doctor review your old medical record, especially if you move or switch insurance plans.  Another doctor’s opinion and insight can be very important to counter this natural feeling of uncertainty.  No one wants to make a bad choice.  Patients aren’t medical experts and generally don’t want to be. Doctors who choose primary care do so because they want to care for the whole patient despite the fact it is among the lowest paid specialties and least attractive to medical students.  Medical students are gravitating towards specialty care which are more procedural based and therefore have the opportunity to generate more income.

Unfortunately, this means doctors who can help patients make informed decisions and prevent overtreatment will be in limited supply at a time when we need them the most.

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23 Responses for “Save Money on Medical Costs – Get Your Old Medical Records”

  1. Fannie says:

    I just requested a hospital record that was stored on an EHR having been for a two week hospitalization. The hospital shipped 1250 pages on monotonous mind numbing gibberish, with the test results buried somewhere in the pile. Would you like to spend your free time gratis going over that record? It is quicker to order another test than to waste time with the crap that now is known as a medical record.

    • Agree. EHR haven’t thoughtfully figured out how to make the data accessible easily when paper copies requested. Inpatient charts and printouts are more complicated and often too many pages for doctors and patients to get the vital information needed to continue providing care. EHR must do better.

      Davis Liu, MD
      Author of Stay Healthy, Live Longer, Spend Wisely: Making Intelligent Choices in America’s Healthcare System
      (available in hardcover, Kindle, and iPad / iBooks)
      Website: http://www.davisliumd.com
      Blog: http://www.davisliumd.blogspot.com
      Twitter: davisliumd

  2. Graham says:

    Soon you’ll be able to get the electronic form which will allow you to get to the results quickly if this hospital’s EHR gets certified.

  3. Graham says:

    And recently I saw a 50s woman whose mother had developed bowel carcinoma in her 40s. I asked this woman when her last colonoscopy was done, and she said her PCP said she didn’t need one until she developed symptoms. I referred her to gastro to get one done.

  4. Peter says:

    “How about getting your old medical records and having them reviewed by a primary care doctor?”

    Ideally your PCP has been your doctor for a long time and the records you want reviewed will be his own. Continuity of care will probably save you more money. If you’ve changed your PCP because you weren’t happy with his care then a fresh look might be in order – sans meaningless records that may continue a false trail. And whose money will you be saving – your own; only if you’re uninsured.

    “It might save you from having an unnecessary test or procedure performed.”

    Where’s the profit in that?

    • Davis Liu, MD says:

      Ideal isn’t happening as patients can’t have long term relationships with a PCP because of changing jobs, employer changing coverage, and / or PCPs dropping out of certain plans. Saving money aspect? Patients have increasing copays and deductibles. The money they save is their own.

      • “…patients can’t have long term relationships with a PCP because of changing jobs, employer changing coverage, and / or PCPs dropping out of certain plans”

        Perhaps we should fix this problem first. Seems to me it is the root cause for everything else.

  5. Janice Reverson, RN says:

    I like the idea of PAs and NPs providing all care and deciding on what test to be done. Now that is a care model that Berwick and Blumenthal should adopt for their own care.

  6. Mark Spohr says:

    It is naive to believe that the “across the board overuse” of medical care by doctors in McAllen, Texas would be fixed if they merely had access to old medical records. It appears that these doctors have developed a system of over-diagnosis and over-treatment that reaps huge financial benefits. (They would probably mine the old records for problems in need of “further investigation”.)
    The rest of your article describes an ethical doctor approach to medical care which we should encourage. Unfortunately, the financial incentives for doctors work to encourage doctors to overuse of diagnostic and treatment procedures of dubious value.

    • BobbyG says:

      My wife is an experienced E-Suite corporate executive, Director of Quality for ITSI Gilbane (a federal specialty construction contractor, mostly). She is paid quite well, her compensation package having been determined by market forces.

      I try to imagine her having to “code” for reimbursement to get paid every two weeks (not that she doesn’t have to “code” her timesheets for contracts allocations).

      • Mark Spohr says:

        I worked for a Federal contractor for one year and it is actually very much like doctors billing. You were “encouraged” to make sure that you billed the maximum hours to your contracts. Not much “free market” here, just bill the contract and make sure you met the terms of the contract. Of course, with Federal contracting, there are limits to the contracts whereas with doctors, the only limits are the doctor’s imagination in coming up with new things to investigate and more expensive tests, treatments and procedures. They can always fall back on “I might get sued if I don’t do this test” and blame it on the lawyers.

        • BobbyG says:

          Oh, yeah, Mark, I agree with much of that. Cheryl use to have to code for “maximum billiabilty” (just like lawyers routinely do) when she was lower level mgmt in her former companies. If your billability rates were too low, you became a layoff target. She was one memo’d that “if you have administrative/managerial duties, code them AFTER you hit 100% billable” — i.e., do your non-client related work on your own time.

          In general, medicine evolved as a different business model (3rd-party reimbursed pymt), one that is now unsustainable. But, everyone hates virtually every reform proposition.

    • Davis Liu, MD says:

      The pojnt of McAllen, Texas, wasn’t about access to old medical records but the fact that there is significant variability in care provided. Patients and the public (and frankly many doctors) find that hard to believe. In that area of variability there is areas where care was unnecessary and costly. Hence the point that something as scientifically proven as the screening time frame for colon cancer can still have doctors recommending differently is concerning. It will end up costing patients more and we all pay a price for that.

      Who will be able to call this out? Other doctors.

  7. I’m sorry, but I am a bit unclear about motive here.
    Was the “previous doctor” in the article a PCP? If so, what exactly was his financial motive to order lots of colonoscopies?

  8. Graham says:

    No, it was gastro who recommended the 5 year repeat colonoscopy.

    The thing is .. quality of care varies greatly, and it doesn’t matter who provides it. Another opinion is a toss up between increasing and decreasing your costs.

  9. propensity says:

    I think that our Congress Reps and Sens should submit CPT like codes (call them GMD {government management descriptors} codes) to the taxpayers for country evaluation and management, lobbying management, national and home office finance management, and disclose via other C (campaign) codes their campaign planning, evaluation, management, and strategy depicting time allotment.

    They need to justify each code submitted with a National Classification of Politics 101 code, enumerating all of the approved activities for Reps and Sens.

    To get paid for their time for any new effort, each new work has to be approved by the taxpayers government work committee (TGWC).

    If too may extended work codes are sent in, eg for lobbying time, there will be an audit so that they can justify each to the taxpayers. Telephone calls will not be paid nor will their be a code for such.

  10. Peter says:

    “I think that our Congress Reps and Sens should submit CPT like codes (call them GMD {government management descriptors} codes) to the taxpayers for country evaluation and management, lobbying management, national and home office finance management, and disclose via other C (campaign) codes their campaign planning, evaluation, management, and strategy depicting time allotment.”

    What, and have transparency in government? Actually the auditor general’s report does a pretty good job, except no one who should pays any attention to it, least of all the voters. But generally you’ll find too much time spent dialing for dollars and too little evaluating legislation/programs. Take heart though, the time that should be spent by congressional reps drafting proper legislation is done by lobbyists writing it for them – a real time saver.

  11. Fannie says:

    Peter implies ghost writing for our lawmakers! Now say that is not true. My oh my!

    And they complain that pharma companies ghost write for the journals using a “big name” for the lead author.

    They have yet to complain that HIT vendors ghost write touting safety of their devices which is not there. Why? The HIT vendors’ trade groups pay more to the lawmakers than do the pharma.

  12. Corinna, RN says:

    I like this relatively simple idea of what almost seems like “old-fashioned medicine”in reviewing medical records. So may tests are performed and specialist are seen each year because of a lack of continuity. PCP’s may choose to leave for a higher-paying speciality position or patients move and then “cannot remember” potentially pertinent health related information. I think this movement, at least on behalf of the patient, has increased from many years ago where people would see their same PCP from infancy through adulthood; all this has possibly led to an increase in referrals & tests. I do agree that as we incorporate more EHR into our profession, that it will become easier to provide more comprehensive care to our patients but I do not feel like that is as much the culprit as educating ourselves and our patients. I know as some standards change, some providers are reluctant to go with the “new” standards and continue to follow the standards they are most comfortable with. Another piece that I believe is responsible huge increase in referrals and testing is the litigious piece. One could probably argue that it would be better to have a normal colonoscopy, albeit uncomfortable, in 5 years, than an abnormal one in 10 years. I believe as long as there are those type of cases, providers may err on the side of caution and overtreat.

  13. Sarah says:

    I regularly get treatment for a chronic disease and I have all my records. I changed insurance plan and the clinic. I showed all my medical records and test results but I was told that I should take all the tests and undergu full examination again. Is that legal or just a rip off?? Thanks!

  14. Richard G.W. says:

    Sahar, it depends on the terms stated in your insurance contract you have signed. If it states that they rely only on the tests done in their clinic then you have nothing but do as they say.

  15. Lorie says:

    I think Dr. order tests they think would be a good idea. Recently my college age daughter visited her OBGYN. The Dr reccomended she have bloodwork done for STD. She said it’s not necessary but a good idea. So of course my daughter did so. Now I have a bill for $361.00-not covered. Now-Doctors need to wake up and realize INSURANCE DOES NOT PAY FOR anything they think is not neccesary. I understand in the good ol days they would be paid by insurance-but the truth of the matter is now I have to choose between tires and over $361.00 of bloodword that was not necessary. Things have changed and insurance is not reliable and Dr. need to realize that they are not going to keep getting paid -PEOPLE CAN’T AFFORD IT! As of today I will no longer got to the dr. I have too much stress worrying on how I will pay for it. This stress over these medical bills will kill me before anything else.

  16. Emily Green says:

    Lorie, didn’t they inform her in any way that the test would be so costly and that it wasn’t covered? If they didn’t it looks like scam on their side. BTW, did the blood test turn out of any actual help?

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