Lab Orders and Insurance Incentives

[Pushing50]

I'm a 50 year old male and recently went to my Family Practice physician for a physicial exam with no major complaints other than seasonal allergies and a mildly decreased urine flow. At the end of the exam the physician gave me a sheet with lab test orders for just two tests: Glucose Fasting (Screen-Diabetes Mellitus) and a Lipid Profile. Keeping in mind that this was the first full physical exam I've had since childhood, I was a bit confused that those were the only lab tests ordered. He said bacause I didn't show any symtoms he would not authorize any additional tests.  I had to beg him to order a PSA because concern over my enlarged protate and because I thought it would be a good idea to establish some kind of baseline value.

Needless to say, I left the office confused and concerned.  I had read articles in the past that indicated some insurance companies were incentivising ($) physicians to keep costs down by not ordering lab tests, etc. I suspect this is what may be happening.

I guess my questions are: 1. For someone my age who is having his first physical exam are there specific lab tests or recommended guidelines that define what lab tests should be ordered?  2. Isn't it a good idea to establish a patients baseline blood chemistry as they enter a higher risk age group? 3. Any idea how prevalent cost-limiting incentives are being offered physicians?

Thanks!

[Kevin Pho, MD]

Your physician is correct.  At age 50, the only tests that are recommended by major medical societies are indeed a fasting sugar, cholesterol, colon cancer screening tests (colonoscopy or stool cards), and a PSA to be discussed with you.

'Baseline' blood chemistries and blood counts are not routinely recommended, although many physicians order these tests regardless, ignoring the guidelines.

The HMO model where costs are monitored is phased out of many areas.  It is unlikely that this is factoring into your physician's decision.  

Followup with your personal physician is essential.

This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.

Kevin, M.D.
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