Lipid Testing Continues After LDL Target Met

A study performed at a Veterans Affairs medical center in Houston, Texas claims that physicians are ordering too many lipid levels on patients with coronary artery disease who have met the LDL (low density lipoprotein) guidelines of <70mg/dl. They looked at 35,191 patients and found that 9200 of these patients had already achieved the desired lipid levels however their clinic physicians ordered a repeat lipid panel on subsequent tests. The researchers cited the Institute of Medicine guidelines which suggest testing your lipid levels only once a year once you have achieved goal levels. If that annual test reveals an elevation of your lipids outside guidelines and it leads to an intensification of your treatment, then they believe it is acceptable to recheck your cholesterol and its subtypes to assess the effectiveness of the treatment.

The study was published in the online edition of the Journal of the American Medical Association (JAMA) by Salim S. Virani, MD PhD of the Michael DeBakey VA and Baylor College of Medicine in Houston. They concluded and an accompanying editorial questioned whether this was an overuse of resources and wasteful spending that was not being discussed by health policy experts because this was low expense non procedural waste and not a big ticket item. They stressed the need to get this wasteful spending under control if we expect to reduce overall health care costs.

In my internal medicine practice, an individual who achieves goal levels of lipids by losing weight, or eating a different diet, or exercising more vigorously or by taking a medicine may in fact alter their habits over a 3-6 month period. They may gain back the weight they lost. They may reduce their exercise due to scheduling conflicts or physical injury and health problems. They may alter their medication regimens or be placed on medicines by other doctors that influence their lipid levels. There are very few patients in my practice that are static and have no changes from quarter to quarter of the calendar year. I make no money sending off blood tests. The lab makes a great deal of money. They have a very high fee schedule for uninsured patients. Their fee schedule for private insurances and Medicare is still far higher than the fee they will charge your doctor if the doctor charges the patient directly and pays the wholesale cost to the lab for that test. Maybe the researchers and cost effective analysts should be looking at the actual cost to the lab of performing the test and insuring that the profit they make is appropriate not price gouging instead of worrying about an additional two or three lipid panels per patient per year. When I send your blood to a reference lab I earn no money on it but do bear the responsibility for interpreting the result and conveying it to you. It seems to me some of the research on cost effectiveness is getting very penny wise and pound foolish.

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