Health chiefs hope to reduce the number of medical tests being carried out at King Edward VII Memorial in a bid to bring down costs at the facility.And the move could also reduce health insurance premiums, which have shot up by as much as 20 percent this year.Last month the Bermuda Hospitals Board (BHB) announced that it could go into debt within a year because of spiralling costs, caused in part by “over-utilisation” of some hospital services.And while it has been suggested that hospital doctors paid on a fee-for-service arrangement may have been “incentivised” to carry out unnecessary procedures, the BHB is now hoping to curb patient demand for tests which may be pointless.The Board is developing ‘best practice’ guidelines to provide “documented clinical evidence justifying certain diagnostic tests”. Managers insist that patients with acute clinical needs will not be denied any tests.At a press conference yesterday, BHB CEO Venetta Symonds said that increased testing did not always produce better results.“The Bermuda Health Council’s reports have indicated that there is a very high level of utilisation in Bermuda,” she said.“People in Bermuda simply have more blood tests, more MRIs and more CTs than almost any other country. The concern is that this is not resulting in improved outcomes for patients. We don’t live longer than people in countries who get tested less — in fact we are generally an unhealthy population with very high incidences of chronic diseases that decrease quality of life and cut our lives short.”Ms Symonds pointed out that, because of revenue caps imposed by the former Government, the hospital was only allowed to earn a set amount for certain services, regardless of how many patients used that service.“There is a cost to over-utilisation,” she said. “We pay for tests we don’t need. While they may satisfy our desires and most likely allay our fears, they don’t help us live longer, healthier lives, and they drive up our insurance premiums.“For BHB, there is also a cost to over-utilisation — we have a limited ability to raise revenue and after certain caps are reached, we no longer are compensated for the work we do.“Our challenge is to set the bar so that every clinically appropriate test is carried out in a timely manner, but that we need to ensure that tests that are not needed are not carried out. This requires us to act as gatekeepers and ensure that there are evidence-backed guidelines that flag unnecessary tests. This process is ongoing, and is informed by our specialists.”A BHB spokesman later said that most jurisdictions employed guidelines on which diagnostic tests should be used.“For example, current guidelines agree that an MRI is not indicated in someone with low back pain unless it lasts longer than six weeks, or unless there are potential ‘warning signs’ such as fever, cancer history, or progressive neurological compromise.“Similarly, a CT scan is not the best diagnostic test to rule out gall bladder stones, an ultrasound test is not only better, but is safer (no radiation) and less expensive. Guidelines help minimise inappropriate imaging. Providing documented clinical evidence justifying certain diagnostic tests, particularly high cost studies, is standard practice in most jurisdictions.“BHB will establish such policies in consultation with physician partners. It is important to note that patients with acute clinical needs will not be denied tests. The intent is to reduce health system costs by minimising excessive testing in the event an exam is not clinically justified or there is a safe alternate lower cost procedure that could be performed.”