Overuse
What is Overuse?
Overuse occurs in two forms: A service is inappropriate for
the clinical scenario, or a service is delivered more frequently
than guidelines recommend.
Example
A stable patient with a history of coronary artery disease
and coronary bypass surgery is referred for imaging stress
testing. However, a prior stress test had been performed
within the previous 24 months, with results that were
comparatively the same or better than prior studies. This
latest imaging test would generally be considered overuse,
as the appropriate use criteria (AUC) frequency guideline
for such scenario calls for the test to be conducted every
five years. Not infrequently, unnecessary imaging stress
tests lead to false positives or equivocal results that
create unnecessarily risky and costly downstream invasive
procedures. In NCH's experience, every time we avoid
an inappropriate stress test, it not only saves an average
of $800 for the test itself, but an average of $4,500 due
to this "waterfall effect."
How Frequently Does Overuse Occur?
• 13% of all low-risk Medicare patients
received nonindicated cardiac testing.
2
• 31% of stress echocardiograms were judged
rarely appropriate, and an additional 23%
were deemed "may be" appropriate.
3
• 35% of cardiac stress tests with imaging
were judged probably inappropriate, with
associated annual costs of $501 million.
4
• 17% of nuclear myocardial perfusion imaging tests
were inappropriate.
5
13%
of all low-risk
Medicare patients
received nonindicated
cardiac testing
31%
of stress
echocardiograms
were judged rarely
appropriate
35%
of cardiac stress tests
with imaging were
judged probably
inappropriate
17%
of nuclear myocardial
perfusion imaging
tests were
inappropriate
