Internet enables medical tests to be low-cost

The June 20th WSJ article "New Online Services ToutLow-Cost Medical Tests" (sub req'd) explains how this works.

At least two new online services have sprung up this year touting these low-cost medical tests. MedLabUSA.com and MyMedLab.com have joined HealthCheckUSA, DirectLabs.com and others in offering to set up patients for the same diagnostic tests as walk-in lab services, hospitals and clinics. Customers visit a Web site, select a specific test, enter a ZIP Code and receive driving directions to a specimen-collection laboratory. Users pay with credit cards or a health savings account and don't need their doctor's prescription -- unlike walk-in clinics, which typically require a personal physician's approval.

Because "most insurers won't pay for such services, however, unless the patient's doctor has ordered the test," this model cuts out the HMOs, insurers and doctors, thus putting the burdens of cost and interpretation on patient-consumers.

(Thanks to sites like the US government's www.nlm.nih.gov/medlineplus, people can interpret their own lab results. Here's an example. Go to the site and type in 'cholesterol level' and click on Search. You'll see two links, What Are Healthy Levels of Cholesterol? from the American Heart Association and Cholesterol: What Your Level Means from the American Academy of Family Physicians, at the top of the search results that tells you what a doctor would tell you when they see your cholesterol numbers.)

The online nature of this model, plus the directness of it thanks to cutting out middlemen, is appealing. "Customers are attracted to the online testing services because they are convenient and cut down on trips to the doctor's office." My opinion is this is ideal for people who are not ill but want to monitor their cholestrol levels to know where their status is.

Another benefit might be that "self-test results don't become part of a medical record, so they aren't reported to insurance companies." This is assuring to those who believe their chances of being hired for full-time jobs are harmed by insurers' and potential employers' foreknowledge of their pre-existing conditions (eg, diabetes) and habits (smoking).

One clarification is due: while a visit to the doctor's office isn't necessary, doctors still are. "The online services say in-house doctors approve requests for tests -- a personal physician's signature is usually required by commercial labs, including [LabCorp], and Quest Diagnostics Inc."

So, what does the medical community think? Well, one doctor, a former AMA president, raises concerns, while another doctor gives a thumbs up.

"Do you know what to do with the results?" asked J. Edward Hill, a Tupelo, Miss., family physician and past president of the American Medical Association. Critics admit that the tests may be helpful in limited scenarios -- checkups to monitor cholesterol-fighting statin drugs, for example -- but too often they mislead patients, potentially leading to higher health costs later.

Despite such concerns, some physicians predict that more health systems will start offering online tests as a service to their patients. "Anything that can get people to a higher level of awareness of their own health status and get them to take some ownership is positive," said Bruce A. Friedman, emeritus professor of pathology at the University of Michigan Medical School.

And what are the cost savings?

A blood test on MyMedLab.com sells for $45, compared with $295 at the local hospital, says company president David Clymer. "We're trying to reach people who are stuck in a market where their only option is a hospital lab," he said. "We're not simply 20% cheaper -- we're 20% of [the hospitals' cost]. That's how consumer-driven health [care] is supposed to be."

However, is this model sustainable? Perhaps not, as "Quest Diagnostics, a leading diagnostic-testing company, ended its online retail unit, QuesTest.com, in March because of poor sales performance... Quest Diagnostics, Lyndhurst, N.J., [still] tests patients at walk-in service centers, but those require patients to have a doctor's order."

And "LabCorp doesn't offer direct-to-consumer tests, citing its desire to keep physicians in the loop. However, most of the online brokers are able to use the LabCorp network for their direct-to-consumer business." For better or worse, it's the entreprenuer who's pushing the trend.