Key Takeaways
- Preoperative testing is standard to ensure a patient’s health, but it may not be necessary in uncomplicated surgeries.
- A pilot program cut unnecessary preoperative testing in low-risk surgeries by about 40%, showing that routine labs, EKGs and imaging often add no clinical benefit.
- Reducing low value testing could save billions in health care costs, lessen patient inconvenience and streamline care without compromising surgical outcomes.
Health care is constantly evolving. As new research, experience and practice add to our knowledgebase, we change the standard of care or the way care is delivered.
Such is the case with some tests that used to be routinely done before certain surgical procedures. Preoperative testing is a way to check for health issues or conditions that could impact the surgical outcome and address them before the procedure. For years, the standard has been for patients to undergo some type of testing before a surgical procedure. This can include blood tests, EKG, urine test, chest x-ray, and in many cases, a stress test.
However, for uncomplicated surgeries in patients who have a low risk for health problems, these preoperative health tests are not helpful, and add unnecessary time, resources and cost. It is estimated that in the United States, $18 billion each year is spent on low-value preoperative testing and follow-up care.
“There is overwhelming evidence that routinely performing preoperative testing on patients undergoing low-risk surgery does not improve outcomes, may be misinformative and introduce delays and wastes health care resources,” said Dr. Hari Nathan, M.D., Ph.D., medical director of the Michigan Value Collaborative.
For example, a healthy patient with no clinical concerns or symptoms might get some slightly abnormal results back. Those results don’t really impact that patient’s risk of surgery, but physicians may decide to order additional testing just in case. And those secondary tests might be invasive or more complicated. Additional testing means more time off work for the patient to get the tests completed, more cost and a possible delay in surgery.
In 2020, the Michigan Value Collaborative (MVC), one of the initiatives within Blue Cross Blue Shield of Michigan’s Value Partnerships program, began examining the rates of low-value preoperative testing in the state. Using the vast amount of data collected from several Collaborative Quality Initiatives, they were able to send reports to Michigan hospitals to make them aware of their testing rates.
Through a federal grant, MVC and the Michigan Surgical Quality Collaborative (MSQC) in 2024 launched the RITE-Size pilot program to encourage and assist participating hospitals in reducing their rates of low-risk preoperative testing. Specifically, the pilot was focused on reducing testing before breast lumpectomy, inguinal hernia repair and laparoscopic gallbladder removal.
“We’ve seen great progress from the pilot program – an average 40% decrease in low-value preoperative testing. We have been recruiting hospitals to participate in a trial evaluating strategies to reduce testing,” Nathan said. “We are soon going to expand the trial from hospital sites to ambulatory surgical centers and possibly to other procedures.”
Getting health care teams to change the standard practice is not easy. Staff members from many different areas are involved and need to be informed, on board and on the same page for a change in procedure to be successful.
“Communication is imperative for this initiative to succeed. In this initiative, participants came together to discuss protocols and ideas. Then they took those ideas back to their individual facilities and set up plans. They check back in with us over a series of coaching sessions. We review data together and identify barriers to change,” said Nathan.
In the expanded trial, the MVC team and participants will be looking at how best to change the protocols at surgical facilities, how to communicate the need for change and the best strategies to educate surgeons, physicians, facility staff and patients.
“The value of this goes beyond hard cost savings. This is a change that improves efficiency, saves people time and worry and makes the health care system work better,” said Nathan.
Learn more about Blue Cross Blue Shield of Michigan's commitment to affordability here.
Support for the RITE-Size program is provided by the Agency for Healthcare Quality and Research (R01HS029306, “De-Implementation of Low-Value Testing in Patients Undergoing Low-Risk Surgery”, Co-Principal Investigators Nathan & Dossett).
Image: Getty Images
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