Doctors groups call for new limits on common medical tests

Fmr. COO Blue Cross/Blue Shield Dr. William Winkenwerder explains

This is a rush transcript from "Your World," April 4, 2012. This copy may not be in its final form and may be updated.

NEIL CAVUTO, HOST OF "YOUR WORLD": My next guest says the public really has nothing to fear from the proposed changes. They were sort of baked into the medical cake for a while.

Dr. Bill Winkenwerder is the former chief operating officer of Blue Cross/Blue Shield.

So, this was coming why, Doctor?

WILLIAM WINKENWERDER, FORMER CHIEF OPERATING OFFICER, BLUE CROSS AND BLUE SHIELD ASSOCIATION: Well, I think it is a good initiative. And I was listening to the lead-in, and the point I would lead with is that we know that there is a lot of overutilization, unnecessary testing, procedures and so forth in medicine and lots of great studies have shown that.

What I like about this initiative is it is coming from the medical profession, it’s coming from the specialty societies, nine different medical groups, and it’s coming in the form of just suggestions for people to think about and for them to consider, both the patients and the doctors to have a discussion.

Most of these recommendations in my judgment are really pretty benign in terms of not getting close to the edge of trying to say you should have this for sure or you shouldn’t have this for sure. So I think it’s responsible.

CAVUTO: What decides that, Doctor? If it comes to an EKG for a woman a breast cancer exam, is it decided based on cost, or you say, it doesn’t look like a problem and you don’t look like you have a problem and all things being equal it is an unnecessary expense or what?

WINKENWERDER: These recommendations are based on medical evidence. The best medical care that we know leads to the best outcomes. They’re not based on cost.

CAVUTO: Then why make them?

WINKENWERDER: Well, because you get better medical care when you do the right thing.

CAVUTO: So I guess we are coming from -- and you might be right, Doctor, but we are coming from a position in this country or view in this country that to test is American, we test, we test, we try to isolate something and we try to get something before it becomes a bad something. And many hear about this and saying, well, they are cutting back on the type of tests and procedures and I could be in a heap of health trouble as a result. You say what?

WINKENWERDER: Well, I say maybe they have done not the best job in terms of communicating what they are trying to do here. You would have to ask them about that.

But I think this is about proper medical practice and about doing the right thing. And, remember, a test really is -- it’s an indication of the probability, either increasing the probability or lowering the probability that something exists or it’s something to need to treat.

CAVUTO: Oh, no, I understand. You are the doctor, I’m not, so I’m not throwing Ben Casey questions at you here.

(LAUGHTER)

CAVUTO: I guess what I am asking is -- and you and I are the only ones who got the Ben Casey reference, Doctor.

(LAUGHTER)

CAVUTO: But I guess what I am asking is I always feel that tests, you can overtest someone, I understand that, but if we start thinking all these tests and these MRIs and these scans, a lot of are not necessary, something will slip through the crack, right?

WINKENWERDER: Neil, let me just make this point. Some of the testing is harmful. Let me give you an example.

We know now something we didn’t use to follow before, but excess exposure to radiation.

CAVUTO: Understood. But what is the harm in an EKG?

WINKENWERDER: Probably not a lot of harm in getting an EKG, but it could lead to a perception that something else is wrong, sort of a false positive, if you will, which leads to another test, which leads to a procedure, and somebody gets hurt or their life, you know, is even taken, by going down the wrong track when nothing was wrong to begin with.

CAVUTO: OK.

WINKENWERDER: So, it is a fine line, I give you that for sure. I just trust that this is the right approach that the groups have tried to come forward with.

And I hope they do a good job or at least a better job than it sounds like they may have already done in terms of communicating the purpose of this.

(CROSSTALK)

CAVUTO: Well, you communicated it a heck of a lot better than they have, sir, so, maybe they should call you.

But, Doctor, thank you very, very much.

WINKENWERDER: Thanks, Neil.

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