The working group homed in on seven areas of overuse, with specific cost savings in several cases:
1. Statins. Low-cost generic statins should be prescribed when initiating cholesterol-lowering treatment rather than high cost, brand-name drugs, saving $5.8 million annually.
2. Sinusitis. Antibiotics are prescribed in more than 80% of outpatient visits for acute sinusitis—accounting for 16 million physician office visits annually—but most cases are due to viral infection that will resolve on its own.
3. Imaging. Lumbar spine imaging for lower back pain before six weeks does not improve outcomes but increases costs. Back pain is the fifth most common reason for physician visits.
4. Electrocardiogram screening. Potential harms of annual ECG screening exceed potential benefits, Morioka-Douglas says. ECGs or other cardiac screening should not be performed annually for asymptomatic, low-risk patients.
5. Pap tests. They “don’t show much in women who’ve had a total hysterectomy for benign disease, and there is poor evidence for improved outcomes,” Morioka-Douglas says.
6. DEXA screening. Bone-density screening for osteoporosis is not cost-effective in younger, low-risk patients. Bone density testing in women under age 65 accounts for $527 million in annual costs.
7. Blood chemistry panels. It’s not necessary to order basic metabolic panels or urinalysis for screening in asymptomatic, healthy adults. When complete panels are performed on asymptomatic patients, only lipid screening yields significant numbers of positive results. Orders of complete blood counts for general medical examinations were associated with $40.8 million in costs.