No More "Battered" Patients

Blue Cross urges curb on hospital lab tests

The routine is familiar to virtually everyone who has ever checked into a hospital. Almost as soon as the patient slips into a hospital gown, he or she faces the standard diagnostic assault. Aptly known in medical jargon as the admission battery, it includes such procedures as a chest X ray, electrocardiogram, blood-cell count, blood-chemistry analysis, venere al-disease test and urinalysis.

Now all that may soon change. Last week the national medical-insurance organization Blue Cross-Blue Shield, which pays medical bills for 112 million Americans, announced that it would pick up the tab for such tests only if the patient's physician specifically ordered them.

This change of policy, which should go into effect within about a year, comes amid increasing criticism that hospital tests are being overused and thus contributing substantially to the nation's skyrocketing medical-care bill, now a whopping $182 billion. The recommendation is part of a sweeping Blue Cross-Blue Shield pro gram designed to keep the insurance premiums at current levels. A year ago the "Blues" stopped paying for 42 surgical procedures considered of doubtful value, saving an estimated $27.4 million a year. This year they plan to phase out payment for 26 obsolete laboratory tests. But the admissions tests, primarily those done on nonsurgical patients, are where the

Blues expect to save the most money.

Some $2.4 billion is now spent annually in the U.S. on the "batteries" -- 37 mil lion hospital admissions at an average of $66 per patient. By making them op tional, Blue Cross-Blue Shield ? could save hundreds of millions of dollars a year. Instituting the economies will f not be easy. As Walter J. McNerney, national Blue Cross-Blue 1 Shield president, explains, "Doctors must change their practices." Trouble is, in recent years the trend has been toward more tests. "Fearing malpractice suits, many physicians defensively order diagnostic tests simply to get them on the record even if they provide no information that will affect the patient's care. Also, with the introduction of expensive new diagnostic devices like computerized X-ray scanners, many doctors have come to equate good medicine with extensive use of such procedures.

But many in the medical com munity agree with the Blues' cam paign that less is more. Says Dr.

Robert Moser, executive vice president of the American College of Physicians, a consultant on the program:

"Good medical practice is more economical. The burden is on the physician to order diagnostic tests with parsimony. A rifle, not a shotgun, approach should be used."

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