The first time a patient called me to say that she'd been billed more than $600 for her Pap smear, I was sure it was a mistake. The second time, I was less sure, and these days I am no longer surprised to find laboratory charges of $1,000 or more for a test that until recently cost only $20 or $30...More at the link. It's an important concept to understand.
It turns out that the high-ticket screening tests contain multiple items: the Pap test itself, usually in the form of a new liquid-based test rather than the older (and cheaper) slide test; a human papillomavirus (HPV) test, which is recommended only for women 30 to 64 years of age and only once every 5 years; tests for sexually transmitted diseases (recommended routinely only for women 15 to 25 years of age and those with symptoms suggestive of an infection); and sophisticated laboratory tests for a variety of yeasts, the presence or absence of which was once assessed by the physician looking at a slide under a microscope. So how do all these tests come to be ordered for healthy women who come in only for an annual gynecology exam? The answer is that someone, whether the physician or nurse practitioner or the medical assistant processing the specimen, checked off all those boxes on the order form...
Laboratories have learned that one easy way to increase revenue is to make it easy for clinicians to order more tests. In the past year, I have been visited by multiple laboratory representatives touting “improved” tests, virtually all of which involve combination panels that can be easily ordered and that contain extensive lists of fairly esoteric tests. The single-vial women's health test is being heavily marketed by multiple laboratories. It includes not only the Pap and HPV tests but also tests for multiple infections — including some we would rarely have tested for in the past — for which we often have no evidence of benefit. Costly tests that once would have required physicians to submit multiple collection vials and specimens can now be ordered with the Pap smear simply by clicking a single box in the electronic medical record. Nothing at any point along the way alerts either the clinician or the patient to the high costs of these tests or to the fact that there is little medical evidence to suggest that they are useful for most patients. It seems harmless, even possibly beneficial, to run these additional tests, and for our staff, it eliminates the risk of missing a test the doctor might have wanted to have run. The risk it poses, though — the one I face when a patient calls about a crippling bill — is that more and more women may choose not to undergo screening, afraid of the financial consequences.
23 October 2013
Why a "pap smear" can cost a thousand dollars
It may not be just a pap smear - it may be a bundled set of tests, as explained in an editorial in the New England Journal of Medicine: