Lab tests: today’s tools for detection, better treatment and greater savings

In my 14 years as a practicing physician in Southwest Louisiana, I had the privilege of caring for thousands of patients.

Each of those patients was unique, each with his or her own medical circumstances and challenges. But virtually all of them would have been better off if their condition had been identified earlier and if treatment or preventive action had been taken much sooner.

For many of those patients, it would have been the difference between life and death.

In the health policy debates in Washington, terms like “early diagnosis” and “preventive care” are the stuff of floor statements and reform proposals. And that’s good. But it is not good if Congress overlooks steps it can take today, right now, to encourage diagnostic testing and preventive care.

Consider what we stand to gain:

Diabetes can cause kidney failure, stroke, blindness and premature death — and costs the U.S. over $130 billion annually.
But laboratory tests can identify the high blood sugar levels that signal danger. This permits physicians to prescribe dietary changes, exercise or medication that can avert such complications and let patients lead normal, healthy lives. In effect, earlier detection and management through lab tests has changed a killer into a chronic disease.

Early detection and management also mean cost savings. A $13 hemoglobin A1c blood test that helps a physician manage a patient’s diabetes reduces the likelihood of heart attack, peripheral artery disease and kidney dialysis.

Cervical cancer is similar. It too is a deadly disease, but early detection and treatment have also made it one of the most preventable. Here, the technology is the Pap test, which provides a kind of early-warning system that detects pre-cancerous cells. This allows physicians to stop cancer before it even starts. In cases where the cancer already exists, the tests detect it in the earliest stages, when treatment is most successful. Since pap tests were introduced, mortality from cervical cancer in the U.S. has dropped roughly 75 percent. Here again, the test not only saves lives; it also saves money. Late-stage cervical cancer treatment costs $37,000, but a pap test that can help prevent this disease costs only $31.

We can count on even further progress on cervical cancer. A new DNA test will improve detection of high-risk strains of the HPV virus that causes cervical cancer, and a new vaccine will significantly reduce the risk of developing the disease.

As a physician, I saw firsthand what early diagnosis and intervention of this kind meant to individual patients. Now as a member of Congress, I see what early diagnosis and preventive care can mean to the U.S. healthcare system overall.

For example, kidney diseases cost the U.S. $8.2 billion each year and the chronic forms of this illness affect some 20 million Americans. Complications include kidney failure, cardiovascular disease and eye damage. But laboratory tests can help patients manage this disease —even slow down or prevent further progression — through earlier diagnosis and treatment. A 2004 study found that expenditures for kidney disease patients who had appropriate diagnostic testing were 50 percent less than expenditures for patients who did not have such tests.

Congress must understand that we have these tools today to help reduce the devastating effects of disease. But we will not realize their benefits through policies that reduce payment and coverage for these technologies. Over the course of many administrations and Congresses, Medicare has continued to try to cut reimbursement for these vital tools through a technique called “competitive bidding.” In reality, this approach is government price setting at its worst, and, as a physician, I can see clear dangers in this approach.

Between surgeries, I would often go to labs in my hometown of Lafayette. I would meet with pathologists to view the most up-to-date, real-time test results for my patients. That gave me a clearer sense of what was going on and what they were facing. But with competitive bidding, lab testing can be outsourced to cities or states that are nowhere near the patients receiving treatment. If this happened, surgeons like me would never be able to have that one-on-one relationship with the pathologist to go over an individual patient’s medical records.

I urge Congress to recognize what we have in lab testing. I further urge my colleagues to support policies that encourage its use and to oppose policies, such as competitive bidding, which will only harm a valuable tool for improving care and reducing costs.

Boustany is a member of the Education and the Workforce Committee.

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