Hello.
I was wondering if I am the only one witnessing a very strange phenomenon from my mother's general practitioner: endless requisitions for tests and scans.
I know that my mother's health is frail, but she is managing to live on her own with assistance from a weekly PSW. She is stable and functioning to the best of her ability.
Within the past year, her general practitioner has become more interested in sending her for many tests: pulmonary function, heart 'stress' tests, mammograms (at 74?) and ultrasounds.
In my opinion: if you look long enough for anything, a problem (that may or may not need intervention) is likely to appear.
With her 'Medicare'-style health insurance, her GP and specialists are able to bill the government for each visit, test and scan.
Is 'overdiagnosis' a risk for senior citizens? Or am I just paranoid that some medical professionals are out to make a buck?
Thanks for listening.
I also have bone density tests so I'll know if I'm getting osteoporosis and can take calcium supplements to bulk up my bones so that I'm at less risk of breaking a bone if I fall, thus ending my life after a broken hip and the follow-ons to that horrible end. So far, so good.
Lab tests tell me if there's blood in my urine, high cholesterol, diabetes, or other things that could kill me before I finish my caregiving of my beloved husband, who has dementia and needs me.
Because I've taken care of myself by getting tests and scans where needed, I am not a burden on others, as perhaps you are thinking your mother is to you. I am here to help others and hope to do that for some time. Like now, with my input to you.
The usual complaints here are about what tests ARE NOT being conducted on seniors thanks to huge waiting lists, a shortage of doctors, and tests being scheduled 6 months or more out.
Your mom can always say no to any test that's recommended. I won't undergo the bone density test, for example, because I would never be able to tolerate the calcium meds that are prescribed if required. Instead, I take a daily normal dose of calcium that doesn't disagree with me and that's that.
GPs make (a little) money for each office visit. And most are booked full, so no financial incentive to over-use visits for any one patient. There would be someone else to see in that “slot” .
So though it may be unnerving and can’t known if appropriate , I don’t think there’s any financial conflict of interest driving it, at least.
My SIL told me the other day that he had ordered a blood panel for a patient and the guy refused to have it done b/c he was 'sick of lining you rich doctors' pockets." SIL just laughed and told the patient "I am on SALARY and I don't get a DIME from any tests that I order for you. And your insurance is covering any and all visits you make to me. I'm not a penny 'richer' caring for you."
This is USUALLY the case. Also, ordering more tests, etc., makes MORE WORK for the Dr.
Guess what? Now hubby and I are those folks going to their primary doctor every 3 months, we extended it to every four months. I was thinking what are the chances of something major changing in 4 months. So far zip.
Our primary doctor has one heck of a physical. It includes a hearing test, eye test, BMI test, respiratory output test, EKG, walking test. And that fun filled 30 question memory test where one draw a clock and sets the time... copy a picture of a box... identify the three animals pictured... remember sentences and repeat back... remember numbers and repeat back... remember numbers and repeat back backwards... remember 6 words and repeat back 15 minutes later... subtract 9 from 93 and continue subtracting... say as many words that begin with "M" (that changes each year)... comparison test.... what day is it... what is today's date... year... place... city. I think that is all. Are we having fun yet?
This is YOUR CHOICE and up to YOU to discuss thoroughly with the MDs. They aren't your boss. The patient is the boss about what he/she wants or doesn't want. This is entirely up to you about what should be done for you, or for your loved one who cannot make these decisions. As my dad's doc said to him when he was weakening "We can do all sort of tests, Fred, to see if you have some blood cancer, or whatever. But if we get a diagnosis, would YOU want to TREAT it?" and my dad replied he would NOT and his doc said "We can save ourselves the testing then!"
Again, this is in YOUR HANDS. Don't give away your rights and your powers over your own choices for your own body, or the body of the person entrusted to you.
For anything billed to Original Medicare, all are preset negotiated terms for payment based on the ICD-10 code submission for billing or whichever Part D prescription drug coverage your mom signed up for. Whether her doc, or an NP or a PA spends 15 minutes with her or takes 90 minutes, the Medicare reinbursement rate is fixed by the code for that visit. Ditto for Medciaid as health insurance. The other health insurers do the same but can adjust upward if it is done outside of the “network” of providers affiliated with the health insurer (Blue Cross, Humana, Advantage Plans, etc).
Imo @ 74 & living on her own, she is “young”.
So often it is question of quality vs quantity.
I am exhausted just taking my husband to every possible specialists followed by tests, procedures, shots, several surgeries, rehab, PTs and endless follow ups. I think he is exhausted and cancelled some lately. Enough, in absence of cure for Parkinson all alternatives offered no improvement, it is progressing faster than ever.
I am 74 and have not gone thur the tests Mom has. But I am not frail. Does Mom have lung and heart problems? If not, I would question why the tests.
"Updated: April 30, 2024.] Women who are at average risk for breast cancer should start mammogram screening at age 40 and get one every two years until age 74."
Not sure if that means after 74 not needed? I had an Aunt that was diagnosed in her mid 80s with breast cancer. She chose not to chemo. I have no family history. Until recently I went yearly. COVID screwed that up. Once I get my next one, I will opt for every 2 yrs. You need to be her Advocate and ask questions. Me at 74 would not go for unnecessary testing. Better be looking for something.
Many PCPs have sold their practices to Hospital groups. These are hospitals with offsight facilities like Xrays and mamograms. So the Doctor just gets a salary. Look at Moms Medicare Statement. The doctor or facility will bill Medicare $200 but Medicare only authorizes $150 of that and of that $150 Medicare pays 80%. So the Doctor gets $120. If you have a supplimental, then the $30 is paid by them. With my supplimental, I have a share clause so I pay some of that 20%. Then there are yearly deductables that have to be met.
I have found that Medicare is bad about paying lab work. These places get practically nothing.
All this should continue until your mom until she is ready to give up. Her best advice is to stay active. Regular exercise reduces symptoms. At 90 my mom had quarterly visits and required blood work just before visits which I scheduled on my own calendar. I am near 70 and I get to see my doctor every 6 months but I also have specialists for conditions. I do not consider myself frail although I do have arthritis and use a cane for flare ups.
Wait till you get to her age, then you will understand
one situation that pissed me off the other day was I took my girlfriend to the dentist for very specific work. But the dentist fought me about first have a cleaning then an exam then come back more times to address the reason you went. I can’t tell you how many times a similar situation has happen with my doctors. I have almost gotten rude with my doctors who are just milking the system. The only way to stop it is to be informed and vocal.
Sample, I totally agree with you
A few right off the bat I would say no to would be the mammogram, if they even utter the word colonoscopy leave the room....
There are medications that do "require" monitoring bloodwork. So if she is on any medications like that and she "needs" the medication then they would be necessary but any others I would question.
I do not think you are paranoid that they are out to make a buck...it is not paranoia if it is true.
So you can stop the "gravy train" by simply saying that you do not want any tests done that are not vital to her well being.
If mom is cognizant she can decline any tests.
If mom is not cognizant and you are POA you can decline any testing
I would suggest you go to the appointments with her to see what is going on. Once you become more involved in her health, you will be able to judge for yourself whether all those test and appointments were necessary.
Medicare fraud is a huge problem. It costs us taxpayers over $60 billion dollars a year (reference: Senior Medicare Patrol, a program funded by the federal governament)
There is a 'potential' for a lot of fraud in billing medi-cal / medi-care / medi-caid.
Have you asked her MD why so many tests?
What is his / her objective(s)?
Are you on your mom's MD chart to get cc (copies) of medical reports? records? You need to have access to all her medical records.
It also MAY BE up to you to decide which / how many tests to authorize her MD to do. Have them ask you / discuss with you before ordering / doing any testing.
You could also do a search on her MD ... to see if there are any public reports.
Good for you being concerned and alerting us. How many times have I heard a 60 Minutes (tv show) talk about these scamming MDs doing this? although I am not saying her MD is ... it is something to consider.
From my perspective, you need to be more involved with her healthcare and decision making.
Gena / Touch Matters
A growing concern among healthcare professionals is the pressure to see more patients and order more tests, often driven by hospital management and financial incentives. Many doctors feel that this approach prioritizes profit over patient care, leading to shorter visits and a reliance on tests rather than thorough history taking and physical exams.
While tests are important, experienced clinicians emphasize that understanding a patient’s history and conducting a hands on examination often leads to better treatment outcomes. The challenge lies in balancing the business side of healthcare with the ethical duty to provide the best possible care—a tension that can lead to frustration and even early retirement for some doctors.
If I understand correctly your mother is only 74 and appears to be healthy. Why would a senior citizen not have these routine tests? A healthy colon is still important at 74. Also important is a good cardiac work up by a vascular cardiologist and always a complete eye exam to rule out Glaucoma and macular degeneration. Early detection of breast cancer is still vital even at age 74. Information from routine tests may not only extend life but may be helpful in preventing a horrible death.
I am a senior and "Science Based Medicine" has contributed greatly to my good health. Cutting edge technology has preserved my 20/20 vision. I am glad you addressed your questions here. While none of this discussion can be considered professional advice it is nice to learn about the experience of others. I do wish you and your mother the best and my compliments to you for the support you give to your mom.
3 days later Kaiser Online Records show a "Call was made for "Shallow Breathing!" I had fine Breathing! No Consent for CT Scan w. Contrast. No Informed Consent to get into Ambulence to Kaiser Emergency. How the Heck did Kaiser get away with? Local Police refused me a request for Police Report of incident. MyvMultiplecComplaint to Kaiser were ignored/ glossed over/diminished! Have been receiving Bills for Ambulence & Wheelchair. I told Durable Med Co. I'd pay for Wheelchair by check in full. They Refused payment in full! Only wanted Credit Card # for 13 months billing. No way I'm giving my Credit Card #! I fear a Subscription Service that never Cancels! NOTE: I NEVER SIGNED ANYTHING DURING THE ENTIRE INCIDENT OF 4 2/2024! Kaiser & Ambulence Billed Medicare for Non-Consent CT Scan w. Contrast & Entire Emergency Room Services/ Procedures of 12 hours! (That I never Consented to.) CT Scan was Negative! X-Ray I don't recall being done, report said "couldn't read!" Kaiser Permanente engaged in flagrant Medicare FRAUD, Illegal Detainment & Battery/ Elder Exploitation/ Elder Abuse!
Beware Irregular attempts to get Elders into Ambulences/Emergency Rooms/Non Consent Procedures!