Yesterday, I took my daughter in for her annual well child check-up.
The nurse practitioner checked her heart and lungs. She talked about puberty and recommended a couple of good books about that before asking about the regular public health checks (tobacco, guns, seatbelts). Finally she did a quick physical exam. My daughter was given a clean bill of health and development. She was also happy; she had no vaccinations due, so we were within thirty seconds of getting out of the appointment without her getting poked by a needle. However the NP said that there was an optional lipid screen that was available if we wanted it. I asked if there were any results that would change her clinical decision making. She said that given all the other measurements she had on my daughter plus her age, there would be absolutely no actionable information from the screening. We declined. My daughter does not like needles, and for once, my dad and health policy geek hats both fit comfortably on my head.
The lipid panel for my daughter would have been no value care. It would have changed nothing in the clinician’s medical judgement. If we had elected to have the blood test, my daughter would have had the cost of dealing with needles and blood, I would have been paying for it, and the clinician would have one more task to acknowledge and manage on a brain that was already hitting cognitive overload.
The claim payment part of low or no value care is easy to measure when there is a moment of low or no value care. Clinician cognitive management costs are harder to measure but they are measurable or at least reasonably estimated. Patient-centric costs of receiving no value care are harder to measure. Speaking as a dad, my daughter’s morning was much better in a no blood draw universe than a universe that had a single, no value blood draw. She would have been stressed out and slightly anxious for at least the entire drive from the doctor’s office back to school.
I wonder if there is an analysis of the non-monetary costs of receiving low or no value care?
Ruckus
Some times a draw can set a baseline, which while possibly not currently useful may come in rather handy later on.
I’d bet low probability with a child.
trollhattan
Well hot dang, seems to work fine. And on my phone to boot.
Lucky nothing was happening today.
Congratulations, crew!
Lum’s Better Half
There is the possibility of early detection of rare conditions (which are currently asymptomatic) that I’m not sure I would discount.
Dr. Ronnie James, D.O.
@Lum’s Better Half: @Lum’s Better Half:
It’s possible but seems unlikely. Familial hypercholesterolemia or other lipid disorders in children are devastating but very rare, and could be picked up without the screen through signs and symptoms (eg you will see things like telltale cholesterol deposits).
At the same time I don’t know why they’d offer the screen for free if there were no preventive benefit. What else would it find? Obesity?
FWIW USPSTF give this an I (insufficient) rating. However, insurers will st pay for screenings that are not USPSTF A or B recommendations. Perhaps this is because they have data about their patients / provider behavior that USPSTF does not.
uspreventiveservicestaskforce.org/Page/Document/RecommendationStatementFinal/lipid-disorders-in-chil…
[Full disclosure: I’m a family practice doc and former public health / health policy wonk who knows very little about the nuts and bolts of health insurance]