No more unneeded tests, hospitals told

EXCLUSIVE: PETALING JAYA: From January, government hospitals will be more prudent in ordering tests for patients to keep costs down.

New guidelines recommending appropriate tests and investigations for the “Top 10” causes of patients being admitted into public hospitals will be implemented.

For example, test and investigation “bundles” would be recommended for pneumonia, diabetes, chest pain and heart failure, as these were common causes of medical ward admissions, Health Ministry deputy director-general Datuk Dr Jeyaindran Sinnadurai told Sunday Star.

The “bundle system” refers to cost and care provided for a medical condition across the entire care cycle.

The move to introduce bundles will address the current problem of doctors ordering too many tests, ordering them too frequently, or relying too much on test results rather than their clinical acumen to treat patients.

There is strong evidence that when care bundles are applied correctly, they can improve the quality, consistency and efficiency of healthcare, Dr Jeyaindran said.

“Bundles achieve better outcomes with lower cost. The Harvard Business Review recently talked about trimming tests and setting a single price for treating a patient’s particular medical condition, as the way forward in cost containment.

“This cost and treatment ‘bundling’ is what we’re doing,” he said.

Over-dependence on tests must stop, he said, adding that doctors should use their clinical skills and acumen to guide them.

Tests, he said, were only to confirm a diagnosis, or estimate the degree of severity.

To keep medical costs affordable, the practice of medicine must be both evidence- and value-based, he said.

Asked if fewer tests would result in misdiagnosis, he said doctors could still order additional investigations if really necessary.

Unlike managed care organisations that provide administrative and processing services for medical claims to insurance companies and employers to keep costs down, bundling was done by medical professionals – not businesses, he said.

“We’re not compromising on safety but you cannot simply order every test possible because you’re afraid of being sued.

“Bundles will only limit unnecessary or inappropriate investigations being ordered – not the doctor’s freedom to order additional tests.

“Doctors can still order tests outside of those listed in the bundle but these must be justified to a senior doctor who will then decide based on the patient’s condition.”

The move was expected to save the ministry between 10% and 15% annually, he said.

Bundling, he added, was not new, as it had been used in other countries and was implemented based on the recommendations in Clinical Pract­ice Guidelines (CPG).

The CPG comprised consensus statements made by experts, he said.